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Paediatrics > Neonatology > Flashcards

Neonatology Flashcards

1
Q

What are the risk factors for neonatal invasive Group B Streptococcus infection?

A 
Preterm babies
PROM
Maternal fever during labour
Maternal chorioamnionitis
Previously infected infant
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2
Q

What does group B strep infection cause?

A

Early onset sepsis - respiratory distress and pneumonia, septicaemia, meningitis

Late onset - meningitis, focal infection

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3
Q

How are mums and babies with GBS positive infection treated?

A

Prophylactic Abx can be given pre-labour

Broad spectrum Abx - amoxicillin or benzylpenicillin

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4
Q

How does cytomegalovirus affect the neonate?

A

40% risk of fetus becoming infected

90% are normal at birth and develop normally
5% have hepatosplenomegaly and petechiae –> neurodevelopmental disability
5% develop problems later in life such as sensorineural hearing loss

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5
Q

How does rubella affect the neonate?

A

Severity decreases with time of infection into pregnancy

Sensorineural deafness
Eye abnormalities - retinopathy, cataracts
Congenital heart disease - pulmonary stenosis, PDA

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6
Q

How does toxoplasmosis affect the neonate?

A

Mother consumes raw/undercooked meat or is in contact with feline faeces

40% of fetuses become infected and 10% of those have clinical manifestations

retinopathy
cerebral calcification
hydrocephalus

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7
Q

How are the HIV positive mother and baby managed?

A

Reduce maternal viral load at time of delivery
Avoid breast feeding
Avoid PROM or instrumentation
Pre-labour C-section if viral load is high

HIV PCR is done in first 3 months of life and ART given

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8
Q

How does syphilis affect the neonate?

A 
Failure to thrive
No nasal bridge
Rash of mouth, anus and genitalia
Blindness
Deafness
Deformities of face
Neurological problems

GIVE PENICILLIN

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9
Q

How does chlamydia affect the neonate?

A

Conjunctivitis along with swelling of eyelids
Pneumonia at 4-6 weeks

GIVE ERYTHROMYCIN

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10
Q

How does gonorrhoea affect the neonate?

A

Chorioamnionitis –> premature labour

Opthalmia neonatorm - purulent discharge, lid swelling, corneal haze –> BLINDNESS

GIVE PENICILLIN

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11
Q

How does herpes affect the neonate?

A

Transmitted via infected birth canal
Can cause local disease to sites of trauma
Affect internal organs
Affect CNS -> encephalitis

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12
Q

What causes bilious vomiting?

A

OBSTRUCTION BELOW DUODENUM

Intussusception
Obstruction
Volvulus
Malrotation
Tumours
Hirschsprung's
Constipation
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13
Q

What does small for age mean?

A

Below 10th centile

Infants are genetically programmed to be this small

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14
Q

What does intrauterine growth retardation mean?

A

Infants are less than genetically predetermined size

Weight and abdo circumference lie on lower centile than head due to brain development taking priority

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15
Q

What causes IUGR?

A

Maternal factors:

  • increased age
  • HTN
  • diabetes
  • alcohol and drug abuse (cocaine)
  • smoking

Placental causes:

  • small placenta that cannot supply needed nutrients
  • pre-eclampsia

Fetal causes:

  • multiple pregnancies
  • intrauterine infections
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16
Q

What are complications of IUGR?

A 
Perinatal and neonatal morbidity
Coronary artery disease
Hypertension
Type 2 DM
Autoimmune thyroid disease
17
Q

What is erythema toxicum?

A

Neonatal urticaria

White pinprick papules at 2-3 days old

18
Q

What are Mongolian blue spots?

A

Blue/black discolourations on base of spine and buttocks

19
Q

What is a cephalohaematoma?

A

Haematoma from bleeding below periosteum confined within margins of skull sutures
Resolves over several weeks

20
Q

How does a brachial plexus injury arise?

A

During breech deliveries or with shoulder dystonia

Damage to C5+6 results in Erb’s palsy which resolves

21
Q

How does sticky eye arise?

A

Small tear ducts become blocked by fluid and debris during birth
Eye is bathed with sterile water

22
Q

How does ABO incompatibility arise?

A

Most ABO antibodies are IgM so don’t cross placenta
Some group O women have IgG anti-A and anti-B haemolysin
These can cross placenta and haemolyse RBC of baby

Can cause severe jaundice but less severe than Rhesus disease

23
Q

What antibodies can cross the placenta?

A

Just IgG

24
Q

How does Rhesus incompatibility arise?

A

Rhesus -ve mother has +ve first child
Produces IgG antibodies against +ve
If second child is +ve then antibodies will cross placenta and cause Rhesus disease

Avoided through anti-D Ig in pregnancy

25
Q

What is CHARGE?

A 
Coloboma of the eye (hole in structure)
Heart defects
Atresia of nasal choanae
Retardation of growth +/- development
Genital/urinary anomalies
Ear anomalies and deafblindness
26
Q

What is anencephaly?

A

Failure of development of most of cranium and brain

Infants are stillborn or die shortly after birth

27
Q

What is encephalocele?

A

Extrusion of brain and meninges through midline skull defect

Can be corrected

28
Q

What is spinal bifida occulta?

A

Failure of fusion of vertebral arch
Skin lesion over lumbar region
Underlying tethering of cord may cause neurological deficits of bladder function and lower limbs with growth

29
Q

What is a meningocele?

A

Skin and meninges form outpouching present with spinal bifida
Cord remains in meninges so fewer problems

30
Q

What is a myelomeningocele?

A

Communication between surface and meninges

–> paralysis, sensory loss, muscle imbalance, neuropathic bladder

31
Q

How do androgens affect sex characteristics?

A

Excessive androgens in females –> virilisation i.e. congenital adrenal hyperplasia

Inadequate androgens - undervirilisation in males
Can be due to decreased response or inability to convert testosterone to DHT

32
Q

How does gonadotrophin affect sex characteristics?

A

Insufficienct (Prader-Willi, congenital hypopituitarism) - small penis and cryptorchidism

33
Q

What causes CAH?

A

Autosomal recessive disorders of adrenal steroid biosynthesis
Deficiency of enzyme 21-hydroxylase needed for cortisol biosynthesis
80% unable to produce aldosterone –> salt loss
Stimulates pituitary to produce ACTH which drives overproduction of adrenal androgens1

34
Q

How does CAH present?

A

Virilisation of external genitalia of female infants - clitoral hypertropy and fusion of labia

Large penis and pigmented scrotum in infant male

Salt-losing adrenal crisis at 1-3 weeks - vomiting, weight loss, floppiness and circulatory collapse

Tall stature in non-salt losers

35
Q

How is CAH managed?

A

Salt losing crisis - IV saline, dextrose and hydrocortisone

Lifelong glucocorticoids to suppress ACTH
Mineralocorticoids

36
Q

How does Potters syndrome occur and present?

A

Bilateral renal agenesis, PKD –> decreased urine and amniotic fluid production
Oligohydramnios –> pressure in utero and decreased pulmonary development

37
Q

What screening tests are done on a Guthrie test?

A 
Congential hypothyroidism
Sickle cell disease
Phenylketonuria (PKU)
Cystic fibrosis
Medium-chain acyl CoA dehydrogenase (MCAD) deficiency
Homocystinuria
Maple syryp urine disease (MSUD)
Glutaric aciduria type 1
Isovaleric acidaemia

Paediatrics (14 decks)

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