Neonatology Flashcards
Which congenital heart lesions are cyanotic? (3)
Those that involve R–>L shunts (blue)
- Tetralogy of Fallot (5%)
- Transposition of great arteries (5%)
Common mixing
- AVSD complete (breathless and blue) – 2%
Which congenital heart lesions are acyanotic? (5)
Generally those with L–>R shunt (breathless)
- VSD (30%)
- ASD (7%)
- Persistent arterial duct (12%)
→ Outflow obstruction if not severe (asymptomatic with murmur)
- PS (7%)
- AS (5%)
- Severe outflow obstruction will present with collapse and shock
Common heart conditions associated with Down syndrome? (2)
- AVSD
- VSD
30% incidence
Common heart conditions associated with Turner syndrome? (2)
- Aortic valve stenosis
- Coarctation of the aorta
15% incidence
RFs for neonatal infection? (6)
- Maternal pyrexia
- PROM
- Prematurity
- Evidence of chorioamnionitis
- Maternal GBS colonization
- Foul smelling liquor
RFs for neonatal GBS infection? (4)
- PPROM
- Maternal fever in labour >38
- Maternal chorioamnionitis
- Previously infected infant
Management for mums and babies if GBS positive mum?
Mums:
- UK → Mothers with RFs for infection offered IV intrapartum abx
- USA/AUS → universal screening at 35-38w to identify carriers then those given IV abx
Babies:
- Usually appears as pneumonia/ sepsis/ meningitis
- Resp distress, apnoea, temp
- Ix → Septic screen: CXR, FBC, cultures, CRP, ?LP
- Rx → Abx immediately – amoxicillin/ benzylpenicillin
What does a septic screen consist of? (6)
FBC CRP Cultures CXR Urinalysis ?LP
Common viral (5) and bacterial (7) pathogens causing infection in newborn?
Viral:
- HSV
- CMV
- HIV
- HBV, HCV
- Rubella
Bacterial:
- GBS
- E Coli
- Gonorrhoea
- Treponema
- Listeria
- Other gram neg
- Atypical → chlamydia, ureaplasma
Most common congenital infection?
CMV
3 types of presentation of congenital CMV?
CID - 5%
- Most severe
- IUGR, hepatosplenomegaly, thrombocytopenia
- 90% neurological sequalae
‘Asymptomatic’ 90%
- Subtle IUGR
Present later in life with neurological sequalae - 5%
- Eg hearing loss
Features of congenital rubella infection?
- Rarely seen now
- Antenatal surveillance – must be confirmed serologically – clinical diagnosis unreliable
- Risk and extent of fetal damage determined by gestational age at onset of maternal infection
- Infection <8w gestation → deafness, congenital heart disease + cataracts in >80%
- 30% of fetuses of mothers infected at 13-16w have impaired hearing
- > 18w – risk to fetus minimal
- Congenital rubella = preventable due to MMR
Management with known maternal HIV?
If undetectable viral load:
- IV ZDV 4h before LSCSS, till cord clamped
- Neonatal ZDV monotherapy for 4w
- Viral PCR at birth, 1m, 3m, 12m
Detectable viral load:
- HAART/ Regimens for mother
- Triple therapy (ZDV + LZMU + NVP)
Clinical features of neonatal sepsis? (many)
- Fever or temp instability or hypothermia
- Poor feeding
- Vomiting
- Apnoea and bradycardia
- Respiratory distress
- Abdo distension
- Jaundice
- Neutropenia
- Hypo/hyperglycaemia
- Shock
- Irritability
- Seizures
- Lethargy, drowsiness
Causes of sticky eyes in neonatal period? (4)
Sticky eyes common in neonatal period – starts day 3, cleaning with saline/water works
Staph/strep - more troublesome discharge with redness
–> abx eye ointment e.g. neomycin
Gonococcal infection - purulent discharge & eyelid swelling in 1st 24h (can lead to blindness)
–> gram stain & culture –> 3rd gen IV cephalosporin
Chlamydia - purulent discharge & eyelid swelling at 1-2w
–> immunofluorescent staining –> oral erythromycin for 2w
Features and management of neonatal HSV?
- Uncommon
- Risk to infant with primary genital infection = 40%
- Risk to infant with recurrent maternal infection <3%
- Most infants infected unexpected as mother asymptomatic
- RF = preterm
- Presentation at any age ≤4w → localized herpetic lesions on skin or eye, or with encephalitis or disseminated disease
- Mortality with localized disease = low
- Disseminated disease mortality = high even with acyclovir
- -> If mother has primary or active recurrent disease at time of delivery → LSCS
- If mother has had in past but not active → acyclovir + vaginal delivery
Define SGA and IUGR?
SGA = birth weight <10th centile
IUGR = fails to meet genetically determined growth potential
What is asymmetrical IUGR?
- Asymmetrical (more common) – abdo circumeference lies on lower centile than head
- Due to placenta failing to provide adequate nutrition late in pregnancy
- Asymmetrical associated with utero-placental dysfunction due to: pre-eclampsia, multiple pregnancy, smoking, idiopathic
- These infants rapidly put on weight after birth
Features/ causes of symmetrical IUGR?
- Symmetrical → prolonged period of IUGR
- Usually small but normal fetes
- May be fetal chromosomal disorder or syndrome, congenital infection, maternal drug/ alcohol use, chronic medical condition or malnutrition
- More likely to remain small permanently
Common causes of asymmetrical IUGR? (4)
- Pre-eclampsia
- Multiple pregnancy
- Smoking
- Idiopathic
Common causes of symmetrical IUGR? (6)
- Normal but small fetus
- Fetal chromosomal disorder/syndrome
- Congenital infection
- Maternal drug/ alcohol use
- Chronic medical condition
- Malnutrition
Short-term complications from IUGR?
- Intrauterine hypoxia
- ‘Unexplained’ intrauterine death
- Asphyxia during labour/ delivery
After birth complications of IUGR? (4)
- Hypothermia as large SA
- Hypoglycaemia from poor fat and glycogen stores
- Hypocalcaemia
- Polycythaemia (venous haematocrit >0.65)
Name the pulmonary causes of neonatal respiratory distress?
Common (1)
Less common (6)
Rare (5)
Common:
- Transient tachypnoea of newborn
Less common:
- Meconium aspiration
- Pneumonia
- Respiratory distress syndrome
- Pneumothorax
- Persistent pulmonary HTN of newborn
- Milk aspiration
Rare:
- Diaphragmatic hernia
- Tracheo-oesophageal fistula (TOF)
- Pulmonary hypoplasia
- Airways obstruction eg choanal atresia
- Pulmonary haemorrhage