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2. Senior Block- Child Health > Neonatology > Flashcards

Neonatology Flashcards

1
Q

When is a baby considered to be ‘severely’ preterm?

A

<28 weeks

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2
Q

When is a baby considered to be ‘very’ preterm?

A

28-32 weeks

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3
Q

When is a baby considered to be ‘moderate/late’ preterm?

A

32-37 weeks

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4
Q

Give 5 risk factors for prematurity

A

Previous preterm delivery
Multiple pregnancy
Smoking and illicit drug use in pregnancy
Under/overweight
Chronic condition- diabetes, hypertension
Physical injury/trauma
Pregnancy problems eg. infection

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5
Q

Give 4 causal categories of preterm delivery

A

Elective due to pregnancy complications (25%)
Emergency delivery (25%)
P-PROM (30%)
No identifiable cause (40%)

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6
Q

What is a Dubowitz/Ballard Examination?

A

Assessment tool to estimate fetal maturity- gives 2 week window of gestation

Based off skin, lanugo, eyes, ears and genital formation + posture and arm recoil

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7
Q

What investigations are done in a preterm neonate?

A 
Blood gas 
FBC
U+Es
Blood culture 
CRP
Blood group and Direct Coombs test 
Chest and abdo x-ray 
Cranial USS- look for hemorrhage
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8
Q

How is a preterm neonate initially managed?

A

Antenatal steroids (in labour)
Magnesium sulfate (neuroprotective)
Parents counselled by senior neonatologist
Thermoregulation help

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9
Q

Explain the resuscitation guidance for babies born at <23 weeks, 23-23+6, 24-24+6 and >25 weeks

A

<23 weeks = no resuscitation
23-23+6 = decision between doctor and parents
24-24+6 = resuscitation commenced unless compromised
>25 weeks = resuscitate and start intensive care

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10
Q

What respiratory problems may a premature neonate experience and how are they treated?

A

Respiratory distress syndrome
Recurrent apnoea

Exogenous surfactant
ET tube
Oxygen
Caffeine

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11
Q

What cardiovascular problems may a premature neonate experience and how are they treated?

A

Hypotension
PDA

Inotrope infusion (adrenaline, dopamine) 
Fluid management
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12
Q

What neurological problems may a premature neonate experience and how are they treated?

A

Intraventricular haemorrhage
Seizures
Cerebral palsy

Surveillance with Cranial USS
Antiepileptics

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13
Q

What gastrointestinal problems may a premature neonate experience and how are they treated?

A

Feed intolerance
Necrotising enterocolitis

TPN
Abx and surgical review- for NEC

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14
Q

What renal problems may a premature neonate experience and how are they treated?

A

Immature renal function

Monitor electrolytes and correct as needed

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15
Q

What metabolic problems may a premature neonate experience and how are they treated?

A

Jaundice
Hyperglycaemia
Hypoglycaemia

Phototherapy
Insulin/IV glucose

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16
Q

What ocular problems may a premature neonate experience and how are they treated?

A

Retinopathy of prematurity

Laser treatment
Avoid excess oxygen

17
Q

When is the Guthrie heel prick test performed?

A

Between day 5 and 8

18
Q

What does the Guthrie heel prick test screen for?

A

PKU, MCADD, MSUD, IVA, GA1, homocystinuria
Cystic fibrosis
Sickle cell
Congenital hypothyroidism

19
Q

Give 4 predisposing factors for neonatal jaundice

A 
Prematurity 
SGA
Low birth weight 
Exclusively breastfed 
Previous siblings needing phototherapy 
Diabetic mother
20
Q

Describe physiological neonatal jaundice

A

Immature liver, increased RBC breakdown

Starts at day 2 and peaks at day 5, resolved by day 10. Baby remains well and needs no extra care

21
Q

Give 5 causes of pathological neonatal jaundice

A 
Haemolytic disease of the newborn 
ABO incompatibility 
G6PD deficiency 
Spherocytosis 
Dehydration 
Bruising/cephalohematoma 
Neonatal infection 
Hypothyroid 
Hypopituitary 
Galactosaemia 
Biliary atresia
22
Q

How is neonatal jaundice investigated?

A 
Transcutaneous bilirubinometer 
Serum bilirubin 
Blood group 
Direct Coombs test (looks for autoimmune haemolytic anaemia) 
FBC
U+Es
TFT
Infection screen
23
Q

How is neonatal jaundice managed?

A

Phototherapy (use treatment threshold graph)
[will need eye protection + breaks for breastfeeding and nappy changes]

Monitor fluid intake

Exchange transfusion- exchange baby’s blood with donor blood

IV Immunoglobulin- in rhesus and ABO incompatibility

2. Senior Block- Child Health (14 decks)

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