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Neonatology Flashcards

1
Q

Before what week are babies classed as premature?

A

<37 weeks

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2
Q

What acute problems can premature babies present with?

A 
Hypothermia
Hypoglycaemia and calcaemia
Necrotising Enterocolitis
Respiratory problems
PDA
Intraventricular haemorrhage
Infection
Haematological problems
Retinopathy of prematurity
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3
Q

Why can premature babies get hypothermia?

A

Lack of subcutaneous fat and inability to shiver

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4
Q

What respiratory problems are seen in premature babies?

A

RDS
Pneumothorax
Apnoea

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5
Q

What haematological problems are seen in neonates?

A

Anaemia - iron deficiency

Jaundice

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6
Q

What causes respiratory distress syndrome of the newborn?

A

Lack of surfactant meaning lungs are non-compliant and stiff

Alveoli are immature and few in number

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7
Q

What are the risk factors of Respiratory Distress Syndrome?

A

Diabetic mother

C Section

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8
Q

How does Respiratory Distress Syndrome present?

A

Signs of respiratory distress - struggle to breathe, tracheal tug etc.

CXR - ground glass appearance, air bronchograms, indistinct heart border

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9
Q

How is Respiratory Distress Syndrome managed?

A

O2
Ventilate - Vapotherm, CPAP then BiPAP
Exogenous surfactant - ET tube
Dexamethasone 48hr prior to delivery

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10
Q

What is the aetiology of necotising enterocolitis?

A

Not fully known. Insult to intestinal mucosa allow commensals to spread

Potentially infective but many have negative culture

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11
Q

How does necrotising enterocolitis present?

A

Within first 2 weeks

Feeding difficulty
Bilious vomiting
Abdo distention
Bloody mucoid stool
Visible bowel loops
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12
Q

What would an AXR of necrotising enterocolitis show?

A

Thickened bowel wall

Gas filled loops

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13
Q

What differentials for necrotising enterocolitis would you consider?

A

Volvulus/malrotation
Intussusception
Haemolytic disease
Meconium ileus

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14
Q

How is necrotising enterocolitis managed?

A

Nil by mouth
NG tube - decompress
IV fluids and TPN
Gentamicin/cefotaxime + metronidazole

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15
Q

What complications are associated with necrotising enterocolitis?

A

Perforation
Sepsis
DIC
Short bowel syndrome

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16
Q

What causes intraventricular haemorrhage in premature babies?

A

Unknown but thought to be due to shearing of bridging veins

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17
Q

How does an intraventricular haemorrhage present?

A

Bradycardia
Cyanosis
Apnoea
Bulging fontanelle within first few days

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18
Q

How is a diagnosis of intraventricular haemorrhage made?

A

Cranial USS

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19
Q

What is the management plan for an intraventricular haemorrhage?

A

Supportive management

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20
Q

Describe the aetiology of retinopathy of prematurity

A

Re-oxygenation following hypoxia means O2 sats increase. This causes proliferation of vessels between vascular and non-vascular retina.

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21
Q

What visual changes can occur in retinopathy of prematurity

A

Decreased visual acuity
Retinal detachment
Blindness

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22
Q

How is retinopathy of prematurity managed?

A

O2 therapy minimised
All preterm see ophthalmologist
Laser photocoagulation

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23
Q

What are the long term problems associated with prematurity?

A

1/4 have hearing impairment
Increased risk of recurrent RTI’s
Behavioural and psychomotor problems - esp. concentration and processing power

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24
Q

When is neonatal jaundice worrying?

A

<24 hours

>14 days

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25
What are the main causes of jaundice <24 hours after birth?
Haemolysis | Infection
26
What haemolytic conditions are you worried about?
Rhesus/ABO mismatch Spherocytosis G6PD Haemolytic disease of the newborn
27
What test would you use to rule out a haemolytic cause to jaundice?
Direct Coomb's test | G6PD levels
28
Where could an infection come from in a neonate <1 day old?
Mothers GU tract Amniotic fluid TORCH - toxoplasmosis, rubella, CMV, herpes
29
If a child is jaundiced between days 2-14, what is the most likely reason?
Physiological - Fetal Hb breakdown and immature liver
30
What are you worried about if a child has prolonged jaundice?
``` Congenital hypothyroidism Breast milk jaundice Biliary atresia Galactosaemia Infection ```
31
What investigations would you carry out on a well baby presenting with jaundice at day 2-3?
Serum bilirubin
32
What investigations would you request for a poorly baby presenting with either early or prolonged jaundice?
``` Bilirubin LFT Infection screen TFT Galactosaemia screen Direct Coombs Blood film G6PD ```
33
How is neonatal jaundice managed?
Supportive - so they don't become dehydrated! Phototherapy - convert unconjugated to conjugated so bilirubin excreted Exchange transfusion - umbilical artery/vein
34
What are the disadvantages to phototherapy?
Disrupt maternal bonding Dehydration Rash
35
What is kernicterus?
Bilirubin induced disorder of the brain. Bilirubin crosses BBB and deposit in basal ganglia and brainstem causing neurological signs
36
How common is kernicterus?
Very very rare! Jaundice is now very well managed
37
What babies are classified as small for gestational age?
10th centile birth weight
38
What are the possible aetiologies for babies that are small for their gestational age?
Baby have low growth at all stages - healthy, could be due to maternal size and ethnicity Baby growth restricted by chromosomal factors or inborn errors in metabolism Baby grow normally through first half but slow in at least 2 measurements due to intrauterine growth restriction.
39
What are the risk factors for a baby being small for its gestational age?
``` Mother >40 Maternal smoking/drug use Maternal low weight/vigorous exercise Maternal HTN, renal disease or anaemia Pre-eclampsia ```
40
How can small gestational age babies be predicted?
Symphysis-fundal height measurements Uterine artery doppler
41
How is SGA prevented/managed?
Smoking cessation advice Single course antenatal steroids Aspirin before 16 weeks if risk of pre-eclampsia Progesterone given to prevent pre-term birth
42
What is intrauterine growth restriction?
A clinical definition of neonates born with growth restriction and features of malnutrition irrespective of their birth weight percentile
43
What are the risk factors for intrauterine growth restriction?
Similar to those for SGA and Interpregnancy interval <6 months and >120 months Mum <16yo TORCH
44
What signs are indicative of intrauterine growth restriction?
Large head with large wide anterior fontanelle Long finger nails Loose, dry, easily peel-able skin Small/scaphoid abdomen Poor skeletal muscle mass and subcutaneous fat - thin arms and legs Loose fold of skin in nape of neck, axilla, inter-scapular area and groins Large thin hands and legs (relative) Thin umbilical cord Poor breast bud formation No buccal fat
45
If the signs of Intra Uterine Growth Restriction are symmetrical, what does this indicate?
Cause of IUGR was early in pregnancy so all measurements equally reduced Poor prognosis
46
If signs of Intra Uterine Growth Restriction are asymmetrical, what does this indicate?
Cause of IUGR late in pregnancy Good prognosis
47
How do infections spread to neonates?
Vertical transmission
48
What does infection spread via vertical transmission?
Spread across placenta Ascending maternal infection and chorioamnionitis Acquired at birth via genital or haematogenous spread Can spread postnatally via breast feeding
49
What protection do neonates have against infection?
Maternal IgG cross placenta
50
Why are preterm babies more at risk of infection?
Process of maternal IgG crossing is less complete
51
What are the long term complications associated with a neonatal infection?
Neurodevelopmental delay Aminoglycoside use - hearing problems Oxygen therapy - retrolental fibroplasia (eye problems)
52
What infections are screened for and how are they treated?
Hep B - Hep B vaccine and Ig given at birth Syphilis - Benzylpenicillin to mum HIV - antiretroviral treatment for mum and baby UTI - give Abx to mum
53
What is the most common cause of severe neonatal infection?
Group B Strep
54
When and how are neonates exposed to group B strep?
In labour 20-40% of mothers have GBS in bowel 25% have GBS in vaginas
55
How would group B strep infections normally present?
Within first week but can be upto 3 months Sepsis, pneumonia or meningitis
56
What are the risk factors for Group B strep infection?
Premature delivery Premature rupture of membranes Previous sibling with GBS infection Maternal pyrexia
57
How are group b strep infections prevented?
Routine screening not offered to all women Testing late in pregnancy (35-37 weeks) if previous GBS detection Maternal IV Benpen prophylaxis offered if: Previous GBS detection Preterm labour Fever >38 during labour
58
How is chicken pox transmitted?
Transplacental Ascending vaginal Contact with lesion at delivery
59
When does the most severe chicken pox rash occur in neonates?
<7 days after delivery
60
How is neonatal chicken pox managed?
Varicella zoster Ig or IV acyclovir if symptomatic
61
What commonly causes neonatal skin infections?
Staph aureus
62
When are skin infections high risk in neonates?
If peri-umbilical as can pass up umbilical vein causing thrombophlebitis
63
What STD's can neonates get?
Syphilis Chlamydia Gonorrhoea Genital herpes
64
How does neonatal syphilis present?
Rhinitis Osteitis Skin bullae
65
How does neonatal chlamydia present?
Pneumonia and conjunctivitis Transmitted at delivery
66
How does neonatal gonorrhoea present? What is it associated with?
Conjunctivitis Associated with increased risk of premature pregnancy
67
How is genital herpes acquired in neonates?
During vaginal delivery
68
Why is genital herpes very severe in neonates?
Cause: Seizures Critical illness Meningoencephalitis Coagulopathies
69
What do you do if you know a pregnant woman has genital herpes?
IV acyclovir C-Section (most asymptomatic so wouldn't know)
70
What is in the Apgar score?
``` Appearance Pulse Grimace Activity Respiration ``` Each scored out of 2 - 10 is healthy
71
When is an Apgar score used?
1, 5 and 10 mins after birth
72
What do Apgar scores indicate?
0-3 - very low score, may need resuscitation 4-6 - moderately low score 7-10 - baby in good state
73
What are the signs an infant is floppy?
Feel limp and floppy Arms and legs straight - should be flexed When help under armpits, arms rise so baby slip through Poor feed - can't suck and swallow Hyperflexible joints Head leg
74
What are the potential causes for a floppy baby? (broad categories)
``` CNS problem Motor neurone Muscle problem NMJ issue Other ```
75
What CNS problems can lead to a baby being floppy
Chromosome abnormalities - Prader Willi. Downs, Noonans, Fragile X Hypoxic-ischaemic injury Congenital hypothyroidism
76
What motor neurone issues can a neonate get?
Spinal Muscular Atrophy (SMA)
77
What NMJ dysfunction can occur in babies?
Myasthenia gravis
78
What muscular issues can babies have?
Myotonic dystrophy - Duchenne or Beckers
79
What investigations would you do for a floppy baby?
MRI CT EEG Bloods etc
80
If a floppy baby had dysmorphic features, what would you think?
Likely to be due to chromosomal abnormality
81
If a floppy baby had a large anterior fontanelle, what would you think?
Hypothyroidism
82
If a floppy baby had drooping eyelids, what would you think?
Myasthenia gravis
83
If a floppy baby had tongue fasciculations, what would you think?
SMA
84
If a floppy baby had hypogonadism, what would you think?
Prader-Willi

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