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Paediatrics RACP Exam Study > Neonatology > Flashcards

Neonatology Flashcards

1
Q

What medications can be given through an ETT?

A
  • L ignocaine
  • A tropine
  • N aloxone
  • E pinephrine (adrenaline)
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2
Q

Where does the spinal cord terminate in a pre-term infant?

A
  • Between L2-L4 (25-40 weeks gestation)
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3
Q

Where should a UVC tip be?

A
  • Above diaphragm but below RA

- T8 to T10

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4
Q

Neonate born by forceps/vacuum extraction with subsequent shock (tachy/low BP), diffuse swelling of the head crossing the sutures, low Hb:

A
  • Subaponeurotic haemorrhage - trauma to blood vessels crossing this space from the skull to the overlying scalp
  • forceps or vacuum extraction.
  • blood under the scalp is far more than is estimated.
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5
Q

High frequency oscillation can increase the risk of…

A
  • Pneumothorax
  • Hyperinflation
  • Airway damage
  • possibly IVH
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6
Q

High frequency oscillation DECREASES the risk of…

A

Chronic lung disease

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7
Q

What are the circulatory changes at birth?

A
  • Blood now flowing through lungs instead of placenta
  • Cut cord -> doubles systemic resistance (low resistance placenta removed) -> ductus venosus closes as no blood from placenta -> decreased RA return as ductus venosus closed.
  • Lung expansion -> decreased pulmonary resistance/PA pressure -> increased pulmonary flow -> increase pulmonary return to LA
  • Overall increased LA pressure > RA and closure of foramen ovale (would normally shunt R -> L)
  • Closure of PDA due to increased arterial oxygen saturation
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8
Q

Indomethacin mechanism of action:

A

COX 1 and 2 inhibitor - decreases prostaglandin synthesis from arachidonic acid

NB: reduces IVH BUT no effect on long term neurodevelopmental outcome

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9
Q

Which drug exposure causes a broad low nasal bridge, epicanthal folds, wide spaced eyes and cardiovascular disease with digital hypoplasia?

A

Phenytoin

Fetal hydantoin syndrome

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10
Q

When does the bone marrow start haematopoesis?

A

7th month

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11
Q

How many calories in breast milk?

A

70kcal/100mL

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12
Q

What factors increase the risk of ROP?

A
  • PREMATURITY is the big one, esp <28/40
  • Small infant - <1500g
  • Oxygen exposure
  • EPO
  • male
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13
Q

What tidal volume are you likely to ventilate a baby at?

A

4-6mL/kg

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14
Q

Where do you see a hypoglycaemic brain injury?

A

Posterior predominant - often visual cortex

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15
Q

What area is most commonly affected in neonatal stroke?

A

Left MCA territory

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16
Q

What is the most important indicator of effective neonatal resuscitation?

A

Rise in heart rate

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17
Q

How do you distinguish between caput + cephalohaematoma vs. subgaleal?

A

Key points:

  • diffuse vs localised swelling for cephalhaematoma, sutures not palpable.
  • <48 hrs blood tracks between the fibres of the occipital and frontal muscles causing bruising behind the ears, along posterior hair line, around eyes
  • Haemodynamic stability
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18
Q

What are the target oxygen saturations for resuscitation of neonates?

A

Starts at 60%-70% at 1min then goes up by 5% per minute

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19
Q

What are protective factors for NEC?

A
  • EBM
  • probiotics
  • limiting rate of increase of trophic feeds to 30mL/kg/day
20
Q

What is the most likely cause of Horner syndrome in the neonate?

A
  • Birth trauma with shoulder dystocia - brachial plexus injury.
  • Klumpke palsy (C8, T1) - “claw hand” where the forearm is supinated and the wrist and fingers are hyperextended.
  • Horner’s secondary to injury of stellate ganglion.
  • unequal pupils
21
Q

How many calories are required for growth in a healthy, preterm infant?

A

120kcal/kg/day

1st week: 80kcal/kg/day (ELBW) or 70kcal/kg/day (LBW)

22
Q

Term infant with bilious emesis 24 hrs after birth and history of polyhydramnios most likely has…

A

…duodenal atresia, which can be seen on AXR as a double bubble and absent distal gas

23
Q

If maternal blood is present on an APT test then what happens?

A
  • Akalised sample goes yellow after 2mins

- If it stays pink, there is HbF

24
Q

What are the possible causes of hyponatremia in a 12 hour old term neonate?

A
  • SIADH secondary to maternal oxytocin administration (similarity to ADH, stimulates renal Na excretion)
  • Could be from excessive maternal fluid administration
  • Could be from excessive fluids for baby (usually okay as long as <90mL/kg/day)
25
Q

What is the main worrying complication of neonatal fat necrosis?

A

Hypercalcemia (25%)

26
Q

What are some of the factors associated with meconium plug?

A
  • Hypermagnesemia
  • Infants of diabetic mothers
  • Cystic fibrosis
  • Hirschsprung disease
27
Q

What are common medications in the NICU that might cause hyponatremia?

A
  • Indomethacin

- Frusemide

28
Q

What is the most common cause of nasal obstruction in a neonate?

A
  • mucosal inflammation
29
Q

What proportion of genetic material is shared (i.e. is identical by descent) between two first cousins?

A

1/8

30
Q

Newborn screening will detect which metabolic disorders?

A

Fatty acid oxidation disorders
Aminoacidopathies
Galactosaemia
Biotinidase deficiency

NOT lysosomal

31
Q

When does nitric oxide not help PPHN?

A

Diaphragmatic hernia

32
Q

What syndromes are associated with craniosynostosis?

A
  • Apert
  • Pfeiffer
  • Crouzon
  • Carpenter
  • Saethre-Chotzen
33
Q

If you see a large facial port-wine stain think…

A
  • Sturge-Weber
  • opthalmology first (as get glaucoma in that eye)
  • brain MRI second (get vascular brain problems)
34
Q

The most common type of oesophageal atresia is:

A

Blind pouch at top; ToF at bottom

35
Q

How do you calculate oxygenation index?

A

(FiO2 X MAP) / PaO2 (all in mmHg NOT kPa)

36
Q

What renal disease would you associate with congenital cataracts?

A

Lowe Disease (oculocerebrorenal)

37
Q

What drug teratogens are most associated with cleft palate and palate?

A
  • Antiseizure agents, such as phenytoin, sodium valproate, and topiramate
  • methotrexate
  • folic acid may be protective
38
Q

What drug teratogens cause deafness?

A
  • Alcohol
  • methyl mercury
  • quinine
  • trimethadione
  • retinoic acid
39
Q

What apparently does not confer additional risk of abusive head trauma?

A

Maternal drug use

40
Q

How much protein do stable preterm infants need?

A

3-4g/kg/day

First week of life about 2-3.5g/kg/day

41
Q

How do you grade IVH?

A

Grade I: A bleed into the germinal layer (subependymal)
Grade II: A bleed into the ventricle with no dilatation
Grade III: A bleed into the ventricle with dilatation
Grade IV : Intraparenchymal haemorrhage

42
Q

Why do babies suck at staying warm?

A
  • Proportional BSA is 3X larger relative to weight
  • Heat loss occurs by evaporation from skin and lungs
  • Convection
  • Hypoglycaemic or hypoxic infants cannot increase O2 consumption when exposed to a cold environment
43
Q

What does zikavirus NOT do?

A

Cause hepatomegaly

44
Q

When do you start making surfactant?

A

Canalicular stage - 17-26/40

45
Q

What blood group combinations give you MORE risk of haemolytic disease of the newborn?

A

Rhesus disease is more common than ABO disease BUT if mother and fetus are rhesus incompatible, the additional ABO incompitability decreases the risk of maternal sensitisation to Rh (because maternal anti-A or anti-B antibodies kill foetal RBC in maternal circulation prior to Rh antibody production)

THEREFORE: Rh incompatible WITHOUT blood group incompatibility is highest risk.

46
Q

How much blood can a baby lose into a subgaleal?

A
  • 50-100mL (20-40%)
47
Q

What type of pulmonary sling can you usually leave alone?

A
  • Innominate artery

Paediatrics RACP Exam Study (30 decks)

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