Neonatology 2- Term admissions Flashcards

1
Q

what are risk factors for neonatal sepsis?

A

prolonged rupture of membranes (>18-24hrs)
maternal pyrexia
maternal group B strep carriage

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2
Q

what is the presentation of sepsis in a neonate?

A
pyrexia or hypothermia
poor feeding 
lethargy or irritable 
early jaundice 
tachypnoea 
hypo or hyperglycaemia
floppy 
asymptomatic
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3
Q

what is first line treatment of presumed sepsis in a neonate?

A

IV penicillin and gentamicin

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4
Q

what is second line treatment of presumed sepsis in a neonate?

A

IV vancomycin and gentamicin

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5
Q

what are the most common causative organisms of sepsis in neonates?

A
group B streptococcus
escherichia coli 
listeria monocytogenes
coagulase-negative staphylococci 
haemophillus influenza
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6
Q

list possible complications of group B strep sepsis in neonates.

A
meningitis
DIC 
pneumonia 
respiratory collapse 
hypotension and shock
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7
Q

congenital infections such as ToRCH can result in what complications?

A
IUGR
intracerebral calcifications, hydrocephalus 
neurodevelopment delay, microcephaly 
visual and auditory impairment 
recurrent infections
splenomegaly 
bone abnormalities 
rash 
anaemia, neutropenia, thrombocytopenia 
hepatomegaly, jaundice, hepatitis 
pneumonitis
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8
Q

what is the pathophysiology of transient tachypnoea of the newborn?

A

delay in clearance of foetal lung fluids

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9
Q

what is the management for transient tachypnoea of the newborn?

A

supportive
antibiotics
fluids
02 airway support

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10
Q

when does transient tachypnoea of the newborn present?

A

within the fist few hours of life

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11
Q

what are the risk factors of meconium aspiration?

A

past dates
maternal diabetes
maternal hypertension
difficult labour

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12
Q

what are the symptoms of meconium aspiration?

A
cyanosis 
increased work of breathing 
grunting 
apnoea 
floppiness
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13
Q

what is the management for meconium aspiration?

A

suction below cord
airways support - intubation and ventilation
fluids (IV)
antibiotics (IV)
surfactant
nitric oxide or ECMO (extracorporeal membrane oxygenation)

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14
Q

what is a possible complication of meconium aspiration?

A

persistent pulmonary hypertension of the newborn

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15
Q

a baby is taken into the A and E who is blue at the lips.

what investigations would you carry out?

A
Hx and examination
sepsis screen
blood gas and blood glucose
CXR
pulse oximetry
ECG
echo
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16
Q

a neonate is admitted to the NNU with hypoglycaemia. what management would you give?

A

start IV 10% glucose
fluids
glucagon
hydrocortisone

17
Q

how is neonatal jaundice managed?

A

phototherapy

if severe - exchange transfusion

18
Q

what are causes of birth asphyxia?

A
placental problem 
long, difficult delivery 
umbilical cord prolapse 
infection 
neonatal airway problem 
neonatal anaemia
19
Q

what are the 2 stages of birth asphyxia?

A

1st;

  • within minutes without oxygen
  • cell damage occurs with lack of blood flow and oxygen

2nd;

  • re-perfusion injury
  • can last days/weeks
  • toxins are release from damaged cells
20
Q

list causes of a neonate unable to pass stool.

A
constipation
large bwoel atresia 
imperforate anus +/- fistula 
hirschsprungs disease 
meconium ileus (think cystic fibrosis)
21
Q

what side is a diaphragmatic hernia most common?

A

left (90%)

22
Q

how is a diaphragmatic hernia in a newborn managed?

A

intubation at birth
respiratory support
ECMO
surgery

23
Q

in what gender is a diaphragmatic hernia most common?

A

boys > girls

24
Q

what score is used to monitor neonatal abstinence syndrome?

A

Finnegan scores

25
Q

how is neonatal abstinence syndrome managed?

A

comfort e.g. swaddling
morphine
phenobarbitone - if morphine not sufficient or substance wasn’t opioid

26
Q

a mother who is a known alcoholic gives birth to a baby boy.
how would you assess if the baby has neonatal abstinence syndrome?

A

urine toxicology

27
Q

what developmental abnormality is associated with diaphragmatic hernia in neonates?

A

pulmonary hypoplasia

28
Q

what are differential diagnoses of the ‘blue baby’ ?

A
truncus arteriosus
Transportation of the great arteries
tricuspid atresia 
tetralogy of fallot 
total anomalous pulmonary venous drainage
29
Q

what is the presentation of hypoxic ischaemic encephalopathy ?

A
floppy 
decreased / absent primitive reflexes 
seizures 
altered consciousness 
acidosis
30
Q

what is the management for hypoxic ischaemic encephalopathy?

A
therapeutic hypothermia 
supportive;
- respiratory 
- cardiac 
- seizures 
fluid restriction
monitor renal and liver failure
31
Q

what puts a newborn at greater risk for GI atresia’s?

A

polyhydramnios in utero