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Phase 3a - Paediatrics > Neonatology > Flashcards

Neonatology Flashcards

1
Q

What are the principles (steps) of neonatal resuscitation?

A
  1. Warm the baby
  2. Calculate APGAR score
  3. Stimulate breathing (i.e. place baby’s head in neutral position to keep airway open)
  4. Inflation breaths (2 cycles of 5 inflation breaths lasting 3 sec each)
  5. Chest compressions (if HR remains below 60 bpm despite resus + inflation breaths then perform chest compressions at 3:1 ratio w/ventilation breaths)
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2
Q

What can prolonged hypoxia increase a risk of in infants?

A

hypoxic-ischaemic encephalopathy (HIE)

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3
Q

What are causes of hypoxic ischaemic encephalopathy?

A
  • Maternal shock
  • Intrapartum haemorrhage
  • Prolapsed cord (copm. of cord during birth)
  • Nuchal cord (when cord is wrapped around neck of baby)
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4
Q

Sx of hypoxic ischaemic encephalopathy?

A

If mild:
* Irritability
* slight changes in behaviour

If severe:
* Hypotonia
* Poor responsiveness to stimuli
* Prolonged seizures
* Multi-organ failure - i.e. hypotension, met

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5
Q

Ix for hypoxic ischaemic encephalopathy?

A
  • EEG monitoring
  • Multiple MRI brain
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6
Q

Mx of HIE?

A
  • Give oxygen
  • Anticonvulsant therapy (control seizures)
  • Therapeutic hypothermia
  • Sedatives if distressed
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7
Q

What is resp. distress syndrome?

A

Syndrome that affects premature neonates born before the lungs start producing adequate surfactant which leads to high surface tension within alveoli. This leads to lung collapse and thus inadequate gas exchange.

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8
Q

Mx of respiratory distress syndrome?

A

Pre-labour:
* Give mothers antenatal steroids (dexamethasone) if preterm labour occurs.

For premature neonates:
* Intubation + ventilation
* Endotracheal surfactant
* CPAP
* If sats low give oxygen

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9
Q

What is necrotising entercolitis?

A

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

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10
Q

RF for developing necrotising entercolitis?

A
  • Very premature
  • Formula fed babies
  • Resp distress + assisted ventilation
  • Sepsis
  • Congenital heart disease
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11
Q

Sx of necrotising entercolitis?

A
  • Intolerance to feeds
  • Vomiting (green bile)
  • Generally unwell
  • Distended, tender abdomen
  • Absent bowel sounds
  • Blood in stools
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12
Q

Ix for necrotising entercolitis?

A
  • Bloods - FBC, CRP, capillary blood gas
  • GS - abdo xray
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13
Q

What are the xray results for necrotising entercolitis?

A
  • Bowel wall oedema (thickened bowel walls)
  • Pneumatosis intestinalis (gas in bowel wall)
  • Pneumoperitoneum (free gas in peritoneal cavity + indicates perforation)
  • Gas in portal veins
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14
Q

Mx of necrotising entercolitis?

A
  • Nil by mouth w/IV fluids
  • Total parenteral nutrition
  • Abx to stabalise them
  • Surgery - remove dead bowel tissue + may require stoma if significant bowel is removed.
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15
Q

What is gastroschisis?

A

Congenital defect (hole) in anterior abdominal wall just lateral to umbilical cord (beside belly button)

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16
Q

Mx of gastroschisis?

A

Newborns should go to surgery as soon as possible after delivery to put intestines back inside abdomen + close up abdo wall

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17
Q

What is meconium?

A

Inaugural faeces passed by a newborn typically after delivery (has thicker consistency + dark green hue). Sometimes it may be expelled before birth into amniotic fluid (meconium-stained liquor) which can signify foetal distress and hypoxia.

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18
Q

What is meconium aspiration?

A

Passage of meconium from amniotic fluid into foetal lungs leading to blockage + infl. of airways which results in lung oedema, pul. vasoconstriction and bronchoconstriction.

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19
Q

Sx of meconium aspiration?

A
  • Meconium stained amniotic fluid
  • Resp distress
  • Foeatal distress
  • Asphyxia
  • Hypotonia
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20
Q

Ix for meconium aspiration?

A

CXR - shows aspiration pneumonitis (patchy infiltrates)

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21
Q

Mx for meconium aspiration?

A
  • Immediate suctioning after birth
  • Oxygen if required
  • Abx if secondary bacterial infx occurs
22
Q

What is TORCH infx?

A

Infx of developing fetus/newborn that can occur in utero, during delivery or after birth.

These infx can lead to a variety of complications including preterm birth, delayed development, physical malformations.

23
Q

What does TORCH in TORCH infx stand for?

A
  • T - Toxoplasma gondii (parasite transmitted through consumption of undercooked meats or exposure to cat faeces)
  • O - Other: syphilis, VZV, parovirus B19, HIV
  • R - Rubella
  • C - CMV
  • H - HSV
24
Q

What are the modes of transmission for TORCH infx?

A
  1. Transmitted to fetus through placenta
  2. Infant may catch infx while passing through birth canal
  3. Mother can pass infx to infant through breast milk
25
Q

How would toxoplasmosis (caused by toxoplasma gondii in TORCH infx) present if passed to an infant?

A
  • Chorioretinitis (choroid and retina in the eye)
  • Hydrocephalus (fluid in brain)
  • Rash
  • Intracranial calcifications
26
Q

How would congenital rubella syndrome (caused by rubella in TORCH infx) present if passed to an infant?

A
  • Deafness
  • Cataracts
  • Rash
  • Heart defect
27
Q

How would congenital CMV (caused by CMV in TORCH infx) present if passed to an infant?

A
  • Rashes
  • Deafness
  • Chorioretinitis (infl. of eye)
  • Seizures
  • Microcephaly
  • Intracranial calcifications
28
Q

What are the 2 types of Herpes Simplex Virus (HSV) and how can they be transmitted?

How does it present if passed on to infants (TORCH infx)?

A
  1. HSV-1 (oral herpes) - transmitted through exchange of oral secretions e.g. kissing, sharing utensils etc
  2. HSV-2 - sexually transmitted

In newborns, HSV is usually transmitted through birth canal.

Sx:
* Blisters
* Infl. of brain (meningoencephalitis)

29
Q

What is Treponema pallidum?

A

Bacterium that causes syphilis

30
Q

How would congenital syphilis (caused by treponema pallidum in TORCH infx) present if passed to an infant?

A
  • Fetal death
  • Craniofacial malformations
  • Rash
  • Deafness
31
Q

How would parovirus B19 (in TORCH infx) present if passed to an infant?

A

Severe reduction in RBCs - lead to anaemia in newborn

32
Q

How would HIV (in TORCH infx) present if passed to an infant?

A
  • Low birth weight
  • Hepatosplenomegaly
  • Recurrent bacterial infx (meningitis or pneumonia)
33
Q

Ix for TORCH infx?

A
  • Prenatal USS
  • PCR test - from amniotic fluid
  • Specific IgM testing for CMV and rubella
34
Q

Tx for the following cdtns (from TORCH infx) in infants:
1. Toxoplasmosis
2. HSV
3. VZV
4. Congenital CMV
5. Rubella
5. Syphilis (treponema pallidum)
6. Parovirus B19

A
  1. Pyrimethamine (antiparasitic) + sulfadiazine
  2. Acyclovir
  3. Acyclovir
  4. Ganciclovir
  5. Supportive tx + surgery if needed to correct heart defects
  6. penicillin
  7. Intrauterine blood transfusions
35
Q

What is brochopulmonary dysplasia?

A

Chronic lung disease of prematurity - lungs not fully developed in infants as a complication of being born prematurely.

36
Q

Mx of bronchopulmonary dysplasia?

A
  • CPAP - breathing support
  • Oxygen
  • Steroids - reduce any infl.
37
Q

How does neonatal jaundice occur?

A
  • Fetus and neonates have less developed liver function and fetal RBCs brakdown more rapidly than normal RBCs. Thus, releasing lots of bilirubin.
  • Usually bilirubin is excreted via placenta
  • However at birth, fetus does not have access to placenta to excrete bilirubin
  • This = normal rise in bilirubin after birth from 2-7 days
  • Usually resolves completely by 10 days
38
Q

The causes of neonatal jaundice can be split into increased production or decreased clearance. Give some examples for each.

A

Increased production of bilirubin:
* Haemolytic disease of the newborn
* ABO incompatibility
* Haemorrhage
* Polycythaemia
* Sepsis and disseminated intravascular coagulation
* G6PD deficiency

Decreased clearance of bilirubin:
* Prematurity (immature liver)
* Breast milk jaundice (components of breast milk inhibit ability of liver to process bilirubin)
* Neonatal cholestasis
* Extrahepatic biliary atresia
* Endocrine disorders (hypothyroid and hypopituitary)

39
Q

Tx of neonatal jaundice?

A

Phototherapy
If extremely high - exchange transfusion (remove blood from neonate + replace w/donor blood)

40
Q

What is kernicterus?

A

Brain damage caused by excessive bilirubin levels. Where bilirubin can cross blood-brain barrier and cause direct damage to the CNS.

41
Q

How does kernicterus present?

A

A less responsive, floppy, drowsy baby w/poor feeding.

42
Q

What are the complications of kernicterus?

A
  • Cerebral palsy
  • Learning disability
  • Deafness
43
Q

What is oesophageal atresia?

A

Congenital disorder in which oesophagus terminates in a blind-ended pouch rather than connecting to the stomach

44
Q

What are the antenatal and postnatal sx of oesophageal atresia?

A

Antenatal:
* Polyhydramnios - excessive amniotic fluid due to baby’s inability to swallow

Postnatal:
* Resp distress
* Distended abdomen
* Choking/problems w/swallowing - TOF cough or excess saliva
* Difficulty passing NG tube

45
Q

Ix for oesophageal atresia?

A

Antenatal - USS
ECHO + renal USS recommended to check for congenital anomalies

46
Q

Mx of oesophageal atresia?

A

Surgical intervention - connect two parts of oesophagus

47
Q

What is bowel atresia?

A

Narrowing in the bowel that occurs during development of fetus before birth leading to segment of bowel not developing properly and causing an obstruction.

48
Q

What is cleft lip and palate?

A

Cleft lip: Congenital deformity where there is a split or open section of upper lip (can extend as high as nose)

Cleft palate: Defect exists in hard or soft palate at roof of mouth which leaves an opening between mouth + nasal cavity

49
Q

Complications of cleft lip and palate?

A

Problems with feeding, swallowing and speech.

50
Q

Tx of cleft lip and palate?

A

Surgical correction - cleft lip usually performed at 3 mths and cleft palate usually done at 6-12 mths.

Phase 3a - Paediatrics (14 decks)

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