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1MRCPCH FOP and TAS > Neonatology > Flashcards

Neonatology Flashcards

1
Q

What is considered a low birthweight in neonates?

A

<2500g

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2
Q

What is considered a extremely low birthweight in neonates?

A

<1000g

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2
Q

What is considered a very low birthweight in neonates?

A

<1500g

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3
Q

What maternal bloods are typically taken for screening?

A

Blood group and antibodies
HepB
Syphilis
HIV
Neural tube defects (raised alphafetoprotein)
T21, T18, T13

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3
Q

When should folic acid supplements be taken to reduce the risk of neural tube defects?

A

Pre-pregnancy and for first 12 weeks pergnancy

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3
Q

By how much does smoking typically affect birthweight of a newborn?

A

Reduced by 200g

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4
Q

when is gestational age typically calculated on AN USS?

A

11-13weeks

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4
Q

What measures should be taken by the pregnancy woman to avoid toxoplasmosis?

A

Avoid undercooked meat
Use gloves for cat litter and gardening

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4
Q

Which women carry an increased risk of neural tube defects in their babies?

A

Obese
Diabetic
On anticonvulsants
Personal or FHx of neural tube defects

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5
Q

What measures should be taken by the pregnancy woman to avoid listeria infection?

A

Avoid soft-ripened cheeses, pate and ready to eat poultry

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5
Q

What measures should be taken by the pregnancy woman to avoid high vitamin A concentrations?

A

Avoid liver

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6
Q

What does maternal obesity increase the risk of for the pregnant mother?

A

Miscarriage
GDM
Pre-eclampsia
Stillbirth
Congenital abnormalities
Macrosomia
Mortality

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6
Q

What measures should be taken by the pregnancy woman to avoid high mercury levels?

A

Avoid swordfish and limit tuna intake

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6
Q

What maternal factors increase the risk of fetal abnormality?

A

Older mother
Previous congenital abnormality
FHx inherited disorder
Parents carry AR disorder
Parents have a chromosomal rearrangement
Consanguinuity

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6
Q

How is fetal growth assessed on USS?

A

Abdominal circumference and femur length

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7
Q

What percentage of congenital abnormality is seen on AN USS?

A

Wide range 50-98% depending of abnormality

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8
Q

What are the potential causes of increased amniotic fluid volume?

A

Maternal DM
Structural GI abnormalities

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8
Q

What are the potential causes of reduced amniotic fluid volume?

A

Reduced fetal UOP
PPROM
IUGR

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9
Q

What can AN fetal blood sampling facilitate?

A

Hb for anaemia
Infection serology
Fetal blood Tx

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9
Q

What investigations can be done on amniocentesis?

A

Chromosome/microarray and DNA analysis
Fetal viral infection

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10
Q

What can AN CVS test for?

A

Chromosome/microarray and DNA analysis
Enzyme analysis of IEMs

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11
Q

What can fetoscopy facilitate?

A

Laser photo-coagulation in twin-twin transfusion syndrome

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12
Q

What is NIPT testing used for?

A

T21, T18, T13 and fetal Rh status

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13
Q

What is the role of tocolysis in preterm labour?

A

Supress uterine contractions and supress labour until AN steroids completed and transfer to a tertiary unit

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14
Q

What are the causes of preterm delivery?

A

Idiopathic
Intrauterine stretch
Endocrine maturation
Intrauterine bleeding
Intrauterine infection
Fetal IUGR or chromosomal abnormalities
Maternal medical conditions
Cervical weakness

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14
Q

What medications can be given to the mother to treat SVT in the fetus?

A

Digoxin
Flecainide

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14
Q

How does glucocorticoid therapy help in preterm delivery?

A

Accelerates lung maturity and surfactant production
Completed course given at least 24hours prior to delivery for optimal effect

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15
Q

What is the role of progesterone in preterm labour?

A

Used as a prophylactic agent in those at high risk for preterm labour

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15
Q

What are the epidemiological risk factors for preterm delivery?

A

Previous preterm infant
Short inter-pregnancy interval
Maternal age <20 or >35
Previous CS
Maternal undernutrition or obesity
Ethnicity (increased rates in black mothers)
Maternal infection
Smoking and substance misuse
Socioeconomic depravation
Maternal psychological or social stress

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15
Q

In the UK what percentage of deliveries are preterm (<37weeks)?

A

7.7%

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15
Q

What is the role of magnesium suplhate in preterm labour?

A

Reduced the risk of CP in infants

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15
Q

What happens to the “donor” twin in twin-to-twin transfusion syndrome?

A

Reduced perfusion pressures
Oliguria and oligohydramnios
Growth often restricted

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15
Q

What are the odds of having triplets in the UK?

A

1 in 8000

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16
Q

What are the odds of having quadruplets in the UK?

A

1 in 700000

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16
Q

What are the odds of having twins in the UK?

A

1 in 90

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16
Q

What is the risk of congenital abnormalities in a singleton pregnancy?

A

2%

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16
Q

What percentage of twins are delivered prematurely?

A

60%

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17
Q

What percentage of twins are delivered <32weeks?

A

11%

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17
Q

What is the risk of congenital abnormalities in dichorionic twins?

A

4%

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18
Q

What is the risk of congenital abnormalities in monochorionic twins?

A

8%

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19
Q

What is the risk of twin-to-twin transfusion syndrome occurring in monochorionic twins?

A

10-15%

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19
Q

What is the survival rate of twin-to-twin transfusion syndrome?

A

60-90%

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20
Q

What happens to the recipient twin in twin-to-twin transfusion syndrome?

A

Hypervolaemia
Polyuria
Polyhydramnios
High-output cardiac failure

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21
Q

What associations are there with poorly controlled DM during pregnancy and delivery?

A

Polyhydramnios
Pre-eclampsia
Increased rates of fetal loss, both early and late
Congenital abnormalities risk increased

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21
Q

What is the increased risk of IUGR of mothers with DM with microvascular disease?

A

3-fold increase

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21
Q

What is the rate of congenital abnormalities in DM and what abnormalities are more prevalent?

A

6%
Cardiac malformations
Sacral agenesis
Hypoplastic left colon

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22
Q

What causes macrosomia in children of diabetic mothers?

A

Maternal hyperglycaemia affects fetus as glucose crosses placenta but insulin does not
Fetus increases rate of insulin secretion which promotes increased cell number and size

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23
Q

What percentage of infants born to diabetic mothers are macrosomnic?

A

25%

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24
Q

What are macrosomnic babies more prone to at birth?

A

Birth asphyxia
Shoulder dystocia
Brachial plexus injury

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24
Q

What neonatal issues are associated with diabetic mothers?

A

Transient hypoglycaemia
RDS
Hypertrophic cardiomyopathy
Polycythaemia

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24
Q

Which groups of mothers are more predisposed to GDM?

A

Obese
Black
Asian
FHx of GDM

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24
Q

What is the risk of newborns of hyperthyroid mothers being hyperthyroid?

A

1-2%

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24
Q

What causes hyperthyroidism in infants of hyperthyroid mothers?

A

Circulation TRab which crosses placenta and binds to TSH receptors, stimulating fetal thyroid hormone production

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24
Q

What are the symptoms of fetal hyperthyroidism?

A

Fetal tachycardia on CTG
Goitre on USS

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25
Q

How is neonatal hyperthyroidism treated?

A

Anti-thyroid drugs until maternal abs clear and symptoms subside

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25
Q

What are the signs of hyperthyroidism in the newborn?

A

Tachycardia
Heart failure
Vomiting
Diarrhoea
Poor weight gain
Jitteriness
Goitre
Exophthalmos

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25
Q

What issues does hypothyroidism typically cause in the neonate?

A

If mother on therapy then nil

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25
Q

How does maternal ITP affect the fetus?

A

Maternal IgG abs cross the placeta and damages fetal platelets causing thrombocytopenia

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25
Q

If an infant is severely thrombocytopenic at birth, what can be given to them?

A

IVIG
Platelet Tx if bleeding

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25
Q

What is the global commonest cause of hypothyroidism?

A

Iodine deficiency

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26
Q

What can sometimes occur to infants born to mothers with anti-Ro or anti-La antibodies

A

Neonatal lupus syndrome

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26
Q

What is SLE with antiphospholipid syndrome associated with in pregnancy?

A

Recurrent miscarriage
IUGR
Pre-eclampsia
Placental abruption
Preterm delivery

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26
Q

Which antiepileptic rugs are commonly known to affect the fetus?

A

Sodium valproate
Carbamazepine
Hydantoins

27
Q

What are the defining features of neonatal lupus syndrome?

A

Rash (self limiting)
Heart block (rarely)

28
Q

How can Tetracycline affect the unborn fetus?

A

Enamel hypoplasia and yellow/brown teeth staining

28
Q

How does fetal valproate/carbamazepine syndrome present?

A

Midfacial hypoplasia
CNS, limb and cardiac malformations
DD

28
Q

How can cytotoxic agents affect the unborn fetus?

A

Congenital malformations

29
Q

How can radioactive iodine affect the unborn fetus?

A

Hypothyroidism

29
Q

How can lithium affect the unborn fetus?

A

Congenital heart defects

29
Q

How does fetal alcohol syndrome present?

A

Decreased HC
Smooth philtrum
Thin upper lip
Small palpebral fissures
IUGR

29
Q

How can SSRIs affect the unborn fetus?

A

Persistent pulmonary hypertension of the newborn

30
Q

What does maternal smoking increase the risk of in pregnancy?

A

Miscarriage
Stillbirth
Abruption
Low birthweight and IUGR

30
Q

How does NAS present neurologically?

A

Neurological excitability
- tremors
- irritability
- high pitched cry
- disturbed sleep-wake cycle
- seizures

31
Q

What non-pharmacological treatments can improve the symptoms of NAS?

A

Skin to skin care
Gentle swaddling
Soft music
Low lighting
Massage
Breastfeeding
Keeping mum and baby together where possible

31
Q

What are the GI symptoms of NAS?

A

Feeding difficulties
D&V
Poor weight gain
Weight loss

32
Q

How can vitamin A and retinoids affect the unborn fetus?

A

Increased rate of spontaneous abortions
Abnormal facies

32
Q

How can Warfarin affect the unborn fetus?

A

Interferes with cartilage formation - ocular and skeletal malformations

32
Q

How can Thalidomide affect the unborn fetus?

A

Limb shortening

32
Q

What pharmacological treatment may be required in NAS?

A

Morphine
Buprenorphine
Methodone

33
Q

In what ways can congenital infection be confirmed in neonates?

A

Serology from baby or mother
Amniocentesis or CVS
Placenta PCR
Urine from infant
Blood/CSF from infant

33
Q

Which immunoglobulin is raised to indicate an infection of rubella, CMV or toxoplasma in an infant or mother?

A

IgM

33
Q

What are the autonomic signs seen in NAS?

A

Fever
Temperature instability
Sweating
Nasal stuffiness
Yawning
Sneezing

34
Q

At what gestation is rubella infection within a mother most harmful to her unborn child?

A

<8weeks gestation

35
Q

What does rubella infection cause to infants if the infection was present at <8weeks gestation?

A

Deafness
Congenital heart defects
Cataracts

36
Q

What does rubella infection cause to infants if the infection was present at 13-16weeks gestation?

A

Hearing impairment in 30%

37
Q

What does rubella infection cause to infants if the infection was present at >18weeks gestation?

A

Risks minimal

38
Q

What are the clinical symptoms in congenital rubella infection?

A

Growth restriction
Eye defects
Pneumonitis
Hepatomegaly and jaundice
Virus in urine
Bone abnormalities
Intracerebral calcifications
Microcephaly
Deafness
Heart defects
Splenomegaly
Rash
Anaemia
Thrombocytopenia
Neutropenia

39
Q

How does congenital CMV present at birth?

A

Most are asymptomatic
Hepatosplenomegaly
Petechiae
SNHL
CP
Epilepsy
Cognitive impairment

39
Q

What is the treatment for neonatal syphilis?

A

Penicillin

39
Q

What eye defects are associated with congenital rubella infection?

A

Retinitis
Cataracts
Microphthalmia

40
Q

What percentage of children who develop congenital VZV syndrome develop a vesicular rash?

A

25%

40
Q

What heart defects are associated with congenital rubella infection?

A

Cardiomegaly
PDA

40
Q

How is toxoplasmosis infection acquired?

A

Raw or undercooked meat
Faeces of infected cats

41
Q

Congenital parvovirus B19 infection is rare, but how does it present?

A

Usually asymptomatic
Rarely anaemia, fetal hydrops and IUD

41
Q

How does fetal varicella syndrome present?

A

Severe scarring of skin
Ocular and neurological damage
Digital dysplasia

41
Q

If infants are born in the high risk period for VZV what treatment should they be given?

A

VZVIG

41
Q

How does congenital toxoplasmosis infection affect the newborn infant?

A

90% asymptomatic
Retinopathy
Acute fundal chorioretinitis
Cerebral calcifications
Hydrocephalus

41
Q

How is congenital toxoplasmosis infection treated?

A

Pyrimethamine and sulfadiazine for 1 year

41
Q

At what 2 satges of development is the fetus particularly susceptable if the mother catches chickenpox?

A

<20weeks gestation
In the last 4 weeks of pregnancy
7 days before or after delivery if viral load is high

41
Q

What is the route of blood flow from the placenta to the heart and brain in fetal life?

A

Umbilical vein, into ductus venosus, into IVC, into RA, through foramen ovale, into LA

42
Q

What medications should be given to mothers exposed to VZV infection?

A

VZVIG
Aciclovir

42
Q
A
42
Q

What percentage of children who develop congenital VZV syndrome die from infection?

A

30%

42
Q

Congenital syphilis presents with very similar symptoms to rubella infection, but what other symptoms may also occur?

A

Rash on palms and soles
Bone lesions

42
Q

What is the route of deoxygenated blood from the fetus back to the placenta?

A

SVC, into RV, into pulmonary artery, into ductus arteriosus, into lower aorta and into placenta via umbilical arteries

42
Q

What should the delivery room temperature be for delivery of preterm infants?

A

26dgerees

42
Q

Which enzyme contributes to physiological jaundice?

A

Uridine diphosphoglucuronyl transferase (UDPT)

43
Q

What is the O2 sats of the upper body in the fetus?

A

65%

43
Q

What stimulates reabsorption of alveolar fluid within the lungs?

A

Increased catecholamine levels at birth

43
Q

At what gestational age should preterm infants be placed directly into a plastic wrap after birth?

A

<32weeks gestation

43
Q

The abnormal presence of what structure leads to Meckels diverticulum?

A

Vitelline duct

43
Q

What is the O2 sats of the lower body in the fetus?

A

35%

43
Q

When should pCO2 parameters be changed in a premature neonate on invasive ventillation?

A

Day 4 (from 4.5-8.5 - 4.5-10kPa)

43
Q

How does congenital rubella infection present?

A

IUGR
Bilateral cataracts
Cardiac anomalies

44
Q

What is the embryological origin of intestinal plexi?

A

Ectoderm

44
Q

How does congenital hypopituitarism present?

A

Microgenitalia
Jaundice
Hypoglycaemia

44
Q

What process leads to duodenal atresia?

A

Failure of full recanalisation of the intestines

45
Q

At what week of development does the embryo develop a gut tube?

A

Week 4

45
Q

Which embryological layer gives rise to the gut tube?

A

Endoderm

45
Q

When does the retinal blood vessel growth typically stop?

A

2-4weeks after birth regardless of gestation

45
Q

What is the embryological mechanism behind congenital diaphragmatic hernia?

A

Failure of the pleuroperitoneal canals to close

46
Q

Which of the embryological cell lines is implicated in the development of DiGeorge syndrome?

A

Neural crest cells

46
Q

Why is haemolytic disease of the newborn usually restricted to rhesus antigen rather than ABO?

A

Antibodies against rhesus antigen are IgG which are the only antibody able to cross the placenta. ABO abs are IgM

46
Q

In a newborn with hypotonia presenting with tongue fasciculations, what is the most likely diagnosis?

A

SMA

46
Q

How is polycythaemia diagnosed from an FBC?

A

Venous Hct >65%

46
Q

What stimulates fetal lung fluid reabsorption?

A

Glucocorticoids

46
Q

What dose of adrenaline should be given to a neonate in cardiac arrest?

A

0.2ml/kg of 1:10000

47
Q

What conditions can cause neonatal hepatitis?

A

Congenital infection
Biliary atresia
Galactosaemia
Tyrosinaemia
A1-antitrypsin deficiency
CF
TPN cholestasis

47
Q

By what gestational age does the skin mature?

A

34 weeks

47
Q

Which ventricle would a ventricular tap typically go into?

A

One of the lateral ventricles - accessed via the anterior fontanelle

47
Q

Which cell membrane channel is responsible for lung fluid reabsorption?

A

Sodium channels

47
Q

What happens to IgG levels in a premature infant?

A

Levels fall to trough level at around 3-4weeks of age - baby is then immunosuppressed until they are able to make their own

47
Q

What type of bacteria is GBS?

A

Anaerobic gram +ve cocci

48
Q

What test is done to confirm a diagnosis of meconium ileus?

A

Contrast enema

48
Q

What would a contrast enema show in meconium ileus?

A

Small-calibre colon
Dilated proximal bowel loops
Pellets of meconium in ileum

48
Q

In what structures of the lung is surfactant synthesised?

A

Type 2 pneumocytes

48
Q

How does congenital toxoplasmosis typically present?

A

Cerebral calcification
Hydrocephalus
Chorioretinitis

48
Q

What is the largest component of surfactant?

A

Phosphatidylcholine (phospholipid)
90% of surfactant is phospholipids and the above makes up 80% of these

48
Q

What physiological process leads to the closure of the foramen ovale following birth?

A

Dilation of the pulmonary vascular bed - increases blood flow to lungs and reduced blood flow to RA.

48
Q

What is microvillous inclusion disease?

A

Rare disorder causing secretory diarrhoea of the intestinal brush border in neonates

48
Q

How is microvillous inclusion disease inherited?

A

AR

48
Q

What infection does meconium staining in a preterm infant suggest?

A

Listeria

48
Q

What is the classical triad of congenital toxoplasmosis?

A

Chorioretinitis
Hydrocephalus
Intracranial calcifications

48
Q

What is the treatment for congenital toxoplasmosis?

A

Pyrimethamine
Sulfadiazine
Folinic acid

48
Q

What is the subunit structure of HbF?

A

2-alpha and 2-gamma chains

49
Q

What vessel follows on from the umbilical vein in neonates when an UVC is inserted?

A

Ductus venosus

49
Q

What is the role of uridine-diphosphoglucuronic gluocuronosyltransferase (UDPGT)?

A

Conjugates bilirubin for excretion by the kidneys

49
Q

What are the risks of exchange transfusion?

A

Hyperkalaemia
Hypo- or hyper- glycaemia
Air emboli
Hypocalcaemia
Acidosis

49
Q

From what gestation is surfactant produced?

A

24 weeks

49
Q

What complications can occur following removal of the ileocaecal valve in NEC?

A

Overgrowth of colonic bacteria in the small intestine

49
Q

What is the main regulatory hormone for terminal maturation of the fetus and neonatal adaptation at birth?

A

Cortisol

49
Q

What are the functions of cortisol in the neonate?

A

Lung maturation
Clearance of lung fluids
Increase of beta-receptor density
Catecholamine release
Maturation of thyroid axis

50
Q
A
50
Q
A
51
Q
A
51
Q
A

1MRCPCH FOP and TAS (23 decks)

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