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Child Health > Neonatology > Flashcards

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
Q

What are the main causes of jaundice <24 hours after birth?

A

Haemolysis

Infection

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26
Q

What haemolytic conditions are you worried about?

A

Rhesus/ABO mismatch
Spherocytosis
G6PD
Haemolytic disease of the newborn

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27
Q

What test would you use to rule out a haemolytic cause to jaundice?

A

Direct Coomb’s test

G6PD levels

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28
Q

Where could an infection come from in a neonate <1 day old?

A

Mothers GU tract
Amniotic fluid

TORCH - toxoplasmosis, rubella, CMV, herpes

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29
Q

If a child is jaundiced between days 2-14, what is the most likely reason?

A

Physiological - Fetal Hb breakdown and immature liver

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30
Q

What are you worried about if a child has prolonged jaundice?

A 
Congenital hypothyroidism
Breast milk jaundice
Biliary atresia
Galactosaemia
Infection
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31
Q

What investigations would you carry out on a well baby presenting with jaundice at day 2-3?

A

Serum bilirubin

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32
Q

What investigations would you request for a poorly baby presenting with either early or prolonged jaundice?

A 
Bilirubin
LFT
Infection screen
TFT
Galactosaemia screen
Direct Coombs
Blood film
G6PD
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33
Q

How is neonatal jaundice managed?

A

Supportive - so they don’t become dehydrated!
Phototherapy - convert unconjugated to conjugated so bilirubin excreted
Exchange transfusion - umbilical artery/vein

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34
Q

What are the disadvantages to phototherapy?

A

Disrupt maternal bonding
Dehydration
Rash

35
Q

What is kernicterus?

A

Bilirubin induced disorder of the brain.

Bilirubin crosses BBB and deposit in basal ganglia and brainstem causing neurological signs

36
Q

How common is kernicterus?

A

Very very rare! Jaundice is now very well managed

37
Q

What babies are classified as small for gestational age?

A

10th centile birth weight

38
Q

What are the possible aetiologies for babies that are small for their gestational age?

A

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
Q

What are the risk factors for a baby being small for its gestational age?

A 
Mother >40
Maternal smoking/drug use
Maternal low weight/vigorous exercise
Maternal HTN, renal disease or anaemia
Pre-eclampsia
40
Q

How can small gestational age babies be predicted?

A

Symphysis-fundal height measurements

Uterine artery doppler

41
Q

How is SGA prevented/managed?

A

Smoking cessation advice
Single course antenatal steroids
Aspirin before 16 weeks if risk of pre-eclampsia
Progesterone given to prevent pre-term birth

42
Q

What is intrauterine growth restriction?

A

A clinical definition of neonates born with growth restriction and features of malnutrition irrespective of their birth weight percentile

43
Q

What are the risk factors for intrauterine growth restriction?

A

Similar to those for SGA and
Interpregnancy interval <6 months and >120 months
Mum <16yo
TORCH

44
Q

What signs are indicative of intrauterine growth restriction?

A

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
Q

If the signs of Intra Uterine Growth Restriction are symmetrical, what does this indicate?

A

Cause of IUGR was early in pregnancy so all measurements equally reduced

Poor prognosis

46
Q

If signs of Intra Uterine Growth Restriction are asymmetrical, what does this indicate?

A

Cause of IUGR late in pregnancy

Good prognosis

47
Q

How do infections spread to neonates?

A

Vertical transmission

48
Q

What does infection spread via vertical transmission?

A

Spread across placenta
Ascending maternal infection and chorioamnionitis
Acquired at birth via genital or haematogenous spread
Can spread postnatally via breast feeding

49
Q

What protection do neonates have against infection?

A

Maternal IgG cross placenta

50
Q

Why are preterm babies more at risk of infection?

A

Process of maternal IgG crossing is less complete

51
Q

What are the long term complications associated with a neonatal infection?

A

Neurodevelopmental delay
Aminoglycoside use - hearing problems
Oxygen therapy - retrolental fibroplasia (eye problems)

52
Q

What infections are screened for and how are they treated?

A

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
Q

What is the most common cause of severe neonatal infection?

A

Group B Strep

54
Q

When and how are neonates exposed to group B strep?

A

In labour

20-40% of mothers have GBS in bowel
25% have GBS in vaginas

55
Q

How would group B strep infections normally present?

A

Within first week but can be upto 3 months

Sepsis, pneumonia or meningitis

56
Q

What are the risk factors for Group B strep infection?

A

Premature delivery
Premature rupture of membranes
Previous sibling with GBS infection
Maternal pyrexia

57
Q

How are group b strep infections prevented?

A

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
Q

How is chicken pox transmitted?

A

Transplacental
Ascending vaginal
Contact with lesion at delivery

59
Q

When does the most severe chicken pox rash occur in neonates?

A

<7 days after delivery

60
Q

How is neonatal chicken pox managed?

A

Varicella zoster Ig or IV acyclovir if symptomatic

61
Q

What commonly causes neonatal skin infections?

A

Staph aureus

62
Q

When are skin infections high risk in neonates?

A

If peri-umbilical as can pass up umbilical vein causing thrombophlebitis

63
Q

What STD’s can neonates get?

A

Syphilis
Chlamydia
Gonorrhoea
Genital herpes

64
Q

How does neonatal syphilis present?

A

Rhinitis
Osteitis
Skin bullae

65
Q

How does neonatal chlamydia present?

A

Pneumonia and conjunctivitis

Transmitted at delivery

66
Q

How does neonatal gonorrhoea present? What is it associated with?

A

Conjunctivitis

Associated with increased risk of premature pregnancy

67
Q

How is genital herpes acquired in neonates?

A

During vaginal delivery

68
Q

Why is genital herpes very severe in neonates?

A

Cause:

Seizures
Critical illness
Meningoencephalitis
Coagulopathies

69
Q

What do you do if you know a pregnant woman has genital herpes?

A

IV acyclovir

C-Section (most asymptomatic so wouldn’t know)

70
Q

What is in the Apgar score?

A 
Appearance
Pulse
Grimace
Activity
Respiration

Each scored out of 2 - 10 is healthy

71
Q

When is an Apgar score used?

A

1, 5 and 10 mins after birth

72
Q

What do Apgar scores indicate?

A

0-3 - very low score, may need resuscitation
4-6 - moderately low score
7-10 - baby in good state

73
Q

What are the signs an infant is floppy?

A

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
Q

What are the potential causes for a floppy baby? (broad categories)

A 
CNS problem
Motor neurone
Muscle problem
NMJ issue
Other
75
Q

What CNS problems can lead to a baby being floppy

A

Chromosome abnormalities - Prader Willi. Downs, Noonans, Fragile X

Hypoxic-ischaemic injury

Congenital hypothyroidism

76
Q

What motor neurone issues can a neonate get?

A

Spinal Muscular Atrophy (SMA)

77
Q

What NMJ dysfunction can occur in babies?

A

Myasthenia gravis

78
Q

What muscular issues can babies have?

A

Myotonic dystrophy - Duchenne or Beckers

79
Q

What investigations would you do for a floppy baby?

A

MRI
CT
EEG
Bloods etc

80
Q

If a floppy baby had dysmorphic features, what would you think?

A

Likely to be due to chromosomal abnormality

81
Q

If a floppy baby had a large anterior fontanelle, what would you think?

A

Hypothyroidism

82
Q

If a floppy baby had drooping eyelids, what would you think?

A

Myasthenia gravis

83
Q

If a floppy baby had tongue fasciculations, what would you think?

A

SMA

84
Q

If a floppy baby had hypogonadism, what would you think?

A

Prader-Willi

Child Health (30 decks)

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