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Paeds > Neonatology > Flashcards

Neonatology Flashcards

1
Q

what is early onset infection

A
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2
Q

signs early onset infection

A

respiratory distress, apnoea, temperature instability

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3
Q

what is late onset infection

A

> 48h after birth. from the infants environment

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4
Q

what organism most common in late onset

A

staph epidermidis (coag negative staph)

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5
Q

signs of neonatal meningitis

A

bulging fontanelle, hyperextension of neck and back (opisothotonus), late signs

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6
Q

what % women carry group B strep

A

10-30%

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7
Q

in colonised mothers what are the risk factors for group B

A

prem, prolonged rupture of membranes, maternal temp >38 in labour, maternal chorioamniotis, previously infected infant

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8
Q

in colonised mothers what are the risk factors for group B

A

prem, prolonged rupture of membranes, maternal temp >38 in labour, maternal chorioamniotis, previously infected infant

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9
Q

signs early onset infection

A

respiratory distress, apnoea, temperature instability

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10
Q

what is late onset infection

A

> 48h after birth. from the infants environment

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11
Q

predictive signs for severe illness in infant

A

seizures, stiff limbs, cyanosis, capa refill >3s, difficulty feeding, t 60, lethargy, grunting, t >37.5

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12
Q

signs of neonatal meningitis

A

bulging fontanelle, hyperextension of neck and back (opisothotonus), late signs

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13
Q

what % women carry group B strep

A

10-30%

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14
Q

if conjunctivitis is purulent discharge swelling of eyelids at 1-2 weeks

A

chlamydia trachomatis- give erythromycin for 2 weeks

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15
Q

in colonised mothers what are the risk factors for group B

A

prem, prolonged rupture of membranes, maternal temp >38 in labour, maternal chorioamniotis, previously infected infant

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16
Q

symptoms of hypoglycaemia in the neonate

A

jittery, irritable, apnoea, lethargy, drowsy, seizures

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17
Q

management early onset infection

A

benzylpenicillin + gentamicin for 10-14 days

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18
Q

management late onset infection

A

flucloxacillin + gentamicin

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19
Q

predictive signs for severe illness in infant

A

seizures, stiff limbs, cyanosis, capa refill >3s, difficulty feeding, t 60, lethargy, grunting, t >37.5

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20
Q

how should high concentration glucose be administered

A

central venous line- to avoid extravasation into the tissue which can cause necrosis and reactive hypoglycaemia

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21
Q

if there is a delay in IV glucose in hypoglycaemia what can be given

A

glucagon or hydrocortisone

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22
Q

if conjunctivitis is purulent discharge swelling of eyelids at 1-2 weeks

A

chlamydia trachomatis- give erythromycin for 2 weeks

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23
Q

when is hypoglycaemia likely

A

IUGR, preterm, born to mother with diabetes, large for dates baby, hypothermic, polycythaemia, ill

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24
Q

symptoms of hypoglycaemia in the neonate

A

jittery, irritable, apnoea, lethargy, drowsy, seizures

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25
Q

how can hypoglycaemia be prevented

A

early and frequent milk feeding

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26
Q

complications of kernicterus

A

CP, LD, deafness

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27
Q

when do you need to give IV glucose in hypoglycaemia

A

asymptomatic and 2 low readings (

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28
Q

causes of jaundice

A

rhesus haemolytic disease, ABO incompatibility, G6PD deficiency, congenital infection- sepsis

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29
Q

if there is a delay in IV glucose in hypoglycaemia what can be given

A

glucagon or hydrocortisone

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30
Q

why do so many newborns become jaundiced

A

release Hb from breakdown red cells due to high Hb conc at birth; red cell life span shorter than in adults; bilirubin metabolism more immature

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31
Q

causes of jaundice >2 weeks

A

unconjugated- physiological, breast milk, infection, hypothyroid, haemolysis, high GI obstruction. conjugated- bile duct obstruction, neonatal hep. biliary atresia

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32
Q

can free bilirubin cross the BBB

A

yes as it is fat soluble

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33
Q

acute symptoms kernicterus

A

lethargy, poor feeding, irritability, incr muscle tone- opisthotonus, seizures, coma

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34
Q

complications of kernicterus

A

CP, LD, deafness

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35
Q

what level bilirubin do infants become clinically jaundiced

A

> 80 umol/l

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36
Q

causes of jaundice

A

rhesus haemolytic disease, ABO incompatibility, G6PD deficiency, congenital infection- sepsis

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37
Q

how can you confirm rhesus haemolytic disease

A

direct coombs test

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38
Q

causes of jaundice 24h-2 weeks

A

physiological, breast milk jaundice, dehydration, infection, haemolysis, bruising, polycythaemia, crigler najer

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39
Q

causes of jaundice >2 weeks

A

unconjugated- physiological, breast milk, infection, hypothyroid, haemolysis, high GI obstruction. conjugated- bile duct obstruction, neonatal hep. biliary atresia

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40
Q

which infants are more susceptible from damage from jaundice so require intervention quicker

A

preterms

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41
Q

what can exacerbate jaundice

A

poor milk intake and dehydration

42
Q

management jaundice

A

phototherapy, exchange transfusion,

43
Q

what does phototherapy do in jaundice

A

converts unconjugated bilirubin into water soluble pigment to be excreted in the urine

44
Q

complications phototherapy in jaundice

A

temperature instability, macular rash, bronze discolouration of the skin

45
Q

what can you give in rhesus haem disease or ABO incompatibility

A

IvIG

46
Q

what are the signs conjugated hyperbilirubinaemia

A

dark urine, pale stools, hepatomegaly, poor weight gain

47
Q

what is exchange transfusion

A

give via umbilical vein, take away via umbilical artery

48
Q

complications exchange transfusion

A

decr pulse, apnoea, decr platelets, decr glucose, decr Na, decr Hb

49
Q

what is resp distress syndrome

A

due to a deficiency in alveolar surfactant leading to alveolar collapse resp failure

50
Q

what does hypoxia lead to in RDS

A

decr cardiac output, hypotension, acidosis and renal failure

51
Q

what are the signs of respiratory distress

A

tachypnoea (>60/min); expiratory grunting, laboured breathing and nasal flaring, cyanosis

52
Q

infants at risk of RDS

A

pre term, maternal diabetes, males, 2nd twin, Csection

53
Q

prevention of RDS

A

betamethasone or dexamethasone to all women 23-35 weeks if expecting to deliver pre term

54
Q

pulmonary causes RDS

A

transient tachypnoea of the newborn, meconium aspiration, pneumonia, pneumothorax, milk aspiration, persistent pulmonary hypertension of the newborn

55
Q

non pulmonary causes RDS

A

congenital heart disease, metabolic acidosis, severe anaemia, intracranial birth trauma/encephalopathy, sepsis

56
Q

what is transient tachypnoea of the newborn

A

due to excess lung fluid. usually resolves within 24h. more common after C section

57
Q

what is meconium aspiration

A

meconium passed in utero leading to meconium stained amniotic fluid. usually pre birth. sign of fetal distress (hypoxia). rarer in pre term.

58
Q

treatment mec aspiration

A

surfactant, ventilation, inhaled NO, antibiotics

59
Q

risk factors for pneumonia in the neonate

A

prolonged rupture of membranes, chorioamniotis, low birthweight

60
Q

risk factors pneumothorax in the neonate

A

spontaneous in 2% births, can be secondary to mec aspiration, RDS, complication of ventilation

61
Q

when does haemorrhagic disease of the newborn happen

A

2-7 days postpartum

62
Q

cause of haemorrhagic disease of the newborn

A

no enteric bacteria to make vitamin K

63
Q

tests in haemorrhagic disease of the newborn

A

PT and PTT incr, platelets no difference

64
Q

prevention haemorrhagic disease of the newborn

A

vit k 1mg IM or 2 doses oral phytomenadione. repeat in

65
Q

treatment haemorrhagic disease of the newborn

A

plasma and vit K for active bleeding

66
Q

when should term babies get back to their birth weight

A

all lose weight in first week. by day 7-10. in pre terms- day 14

67
Q

potential problems with breastfeeding

A

latching on, cracked nipples, breast engorgement, intestinal hurry

68
Q

potential problems with bottle feeding

A

incorrect reconstitution, allergy, inadequate sterilisation

69
Q

what is tested for in the Guthrie screening

A

at 5-8 days. maple syrup urine disease, CF, congenital hypothyroidism, PKU, MCADD, sickle cell

70
Q

what happens in HIE

A

perinatal asphyxia- gas exchange impaired or stops, cardioresp depression. hypoxia, hypercarbia, metabolic acidosis

71
Q

causes HIE

A

failure gas exchange across the placenta- excessive uterine contractions, placental abruption, ruptured uterus; interrupted umbilical blood flow- compressed cord; inadequate maternal perfusion; compromised fetus- anaemia, IUGR; failure to breathe

72
Q

signs mild HIE

A

irritable, responds excessively to stimulation, impaired feeding

73
Q

signs moderate HIE

A

abnormal tone and movement, cant feed, seizures

74
Q

signs severe HIE

A

no normal spontaneous movement or response to pain, hypo and hypertonia. seizures, multi organ failure

75
Q

management HIE

A

resp support, record EEG, treat seizures, fluid restriction, vol and inotrope support, monitor BM and electrolytes

76
Q

prognosis HIE

A

mild- complete recovery. severe- mortality 30-40%, >80% of survivors- neurodevelopmental disability

77
Q

what can congenital rubella cause

A

18 weeks damage to the fetus is minimal

78
Q

which is the commonest congenital infection

A

CMV

79
Q

what are the features of CMV

A

hepatosplenomegaly, petechiae, neurodevelopmental disability

80
Q

clinical manifestations toxoplasmosis

A

retinopathy, cerebral calfication, hydrocephalus

81
Q

what can appear in congenital syphillis

A

rash on soles of feet and hands

82
Q

what is erythema toxicum

A

neonatal urticaria. rash appears 2-3d. white pin point papules at centre of erythematous base. lesions concentrated on the trunk. goes in 24h

83
Q

what can retinopathy of prematurity lead to

A

retinal detachment, fibrosis, blindness

84
Q

risk factors for retinopathy of prem

A

prem, low birthweight. screen if

85
Q

signs of IVH

A

seizures, bulging fontanelle, cerebral irritability. do ultrasound and CT

86
Q

complications IVH

A

IQ decr, CP, hydrocephalus

87
Q

what can decr the risk of IVH in prems

A

delayed cord clamping

88
Q

what happens to pulmonary vascular resistance with the first breath

A

falls, rush of blood to lungs

89
Q

what helps promote adult circulation (lungs)

A

inhaled NO

90
Q

complications of mechanical ventilation neonates

A

pneumothorax, pulmonary haemorrhage, bronchopulmonary dysplasia, emphysema, pneumona; upper airway obsrruction; PDA, incr ICP, IVH, RoP

91
Q

causes of neonatal seizures

A

HIE, infection, ICH, structural CNS lesions, metabolic (decr glucose, decr Ca, Na up or down, decr Mg)

92
Q

treatment neonatal seizures

A

first line-phenobarbital. 2nd line phenytoin

93
Q

why would the red reflex be absent

A

cataract, retinoblastoma

94
Q

causes of apnoeic attacks

A

resp centre immaturity, aspiration, heart failure, infection, PaO2 decr, glucose decr, Ca decr, seizures, PDA, temp up or down, exhaustion, airways obstruction

95
Q

what is NEC

A

inflammatory bowel necrosis

96
Q

what is the main risk factor for NEC

A

prem. otherss- weigh

97
Q

signs NEC

A

mild- abdominal distension. blood and mucus PR. severe- sudden distension, tenderness, shock, DIC, mucosal sloughing.

98
Q

what is pathogneumonic for NEC

A

pneumatosis intestinalis (gas in gut wall seen on x ray)

99
Q

treatment nec

A

stop oral feeding, culture faeces, crossmatch, give antibios- cefotaxime + vancomycin. laparotomy if progressive distension perforation

100
Q

prophylaxis of nec

A

expressed breast milk, probiotics, oral antibiotics

101
Q

presentation biliary atresia

A

jaundice, yellow urine, pale stools. biliary tree occlusion by angiopathy at week 3. splenomegaly. cholestasis

102
Q

management biliary atresia

A

surgery- Kasai procedure and intestinal limb to drain bile from porta hepatis. if operation is late- cirrhosis. will need liver transplant in first year of life

Paeds (16 decks)

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