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Phase 3a > Neonatology > Flashcards

Neonatology Flashcards

1
Q

what are causes of a prem baby

A

idiopathic

infections

iugr

congenital abnormalities

preeclampisa

interuterine bleed

cervicle weakness

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2
Q

what is the management of an at risk prem baby

A

antenatal corticosteroids (reduces risk of prem ROM)

glucocorticoids (reduce rds risk)

antibiotics

tocolysis (suppress prem labour)

magnesium sulphate (reduce CP risk)

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3
Q

what are complications of prematurity

A

RDS

pneumothorax

PDA

necrotising enterocolitis

retinopathy

bronchopulmonary displasia

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4
Q

how do you staibalise a prem baby

A

resp breaths

incubator

O2 on high flow nasal cannula/CAPAP

periferal and umbillical lines

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5
Q

what is gestational diabetes

A

previous non diabetic developing high blood sugars during pregnancy

due to carbohydrate intolerance and insulin resistant state of pregnancy

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6
Q

what are the RF for gestational diabetes

A

PCOS

pre diabtes

increased maternal and paternal age

overweight

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7
Q

how do you chech for gestational diabetes in pregnancy

A

glucose tolerence test at 28 weks in high risk women

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8
Q

describe the glucose tolerence test

A

nin fasting + 50g glucose load

testes one hour later

2 or more abnormal tests = diabetes

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9
Q

what is the management of gestational diabetes

A

insulin = aim to prevent fetal macrosomia

c section if macrosomia

GTT 6 weeks post partum

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10
Q

what complications does maternal hyperthyroidism pose to baby

A

prem

iugr

higher risk of perinatal mortality

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11
Q

what are maternal complications of hyperthyroidism

A

infertility

miscarrige

cardiac failure

thyroid storm

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12
Q

how do you manage maternal hyperthyroidism

A

propythiouracil (better than carbimazole in pregnancy)

regular fetal US to chech tachycardia (thyroid dysfunction) after 32 weeks

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13
Q

what features of pregestational diabetes would indicate a poor prognosis

A

uncontrolled diabetes

DKA

Pyleonephritis

vasculopathy

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14
Q

what is the management of poorly controlled pre diabetes

A

good control prior to conception

check HBA1C

in labour: IV glucose and 1-2hrly BMs

insulin

metformin

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15
Q

what fetal complications may arise due to pregestational diabetes

A

congenital malformations (like CHD)

iugr

macrosomia

birth asphixia

shoulder dystocia

nerve paulseys

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16
Q

what is the presentation of fetal hypoglycaemia

A

sweating

irritability (due to abdo pain)

pallor

hunger

lethargy

seizures

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17
Q

why is fetal hypoglycemia common in first day of life

A

fetal hyperinsulinism

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18
Q

what are RF for fetal hypoglycemia

A

IUGR

prem

T1+2 DM maternal

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19
Q

why do prem babys have higer risk of becoming hypoglycemic

A

low / no glycogen stores

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20
Q

why do babys with DM T1+2 have higher risk of hypoglycemia

A

due to hyperplasia of islat cells causing hyperinsulinism

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21
Q

how do you diagnose hypoglycemia

A

x2 low readings

or

x1 very low reading

or symptomatic

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22
Q

how do you treat fetal hypoglycemia

A

iv glucose + glucagon/hydrocortisone

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23
Q

how do you treat an a granuloma (umbilical )

A

silver nitrate topical

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24
Q

what cab GBS cause

A

early or late sepsis

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25
Q

describe the early presentation of sepsis

A

RDS

pneumonia

septicemia

meningitis

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26
Q

describe the presentationof late onset sepsis

A

meningitis: irritability, neck stiffess, unlwell

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27
Q

when does late onset sepsis occur

A

7days-3months post delivery

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28
Q

how does late onset sepsis occur

A

BS carried on skin or mucosa

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29
Q

what are RF for sepsis

A

prolonged ROM

maternal fever

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30
Q

when do you check for GBS

A

35-38w

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31
Q

a pregnant lady is positive for GBS at 35w what is her management

A

proflactic intrapartum abx

  • penicillin
  • vancomycin

and give same ABx to child within 2-4h of birth

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32
Q

what is RDS

A

surfactant deficiency causes a decrease in surface tension causing alveolar collapse and inadequate gas exchange

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33
Q

what is surfactant

A

phospholipids and protein excreted by T2 pneumocytes

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34
Q

what are the RF for RDS

A

prem <28weeks

male has worse severity

maternal diabetes

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35
Q

what is the presentation f RDS

A

tachyopnea

laboured breathing

chest wall recession

nasal flaring

expiratory grunting

cyanosis

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36
Q

how do you manage RDS

A

if suspected premature antenatally give glucocorticoids

then:

O2/CPAP

surfactant therapy via trachyal tube

37
Q

what is bronchopulmonary displasia

A

lung damage due to trauma from o2 therapy, infections, artificial ventilation.

this lung damage means infants have high o2 requirements past 36 weeks

38
Q

what is the diagnosis of bronchopulmonary displasia

A

clinical

x ray = wide spread opacification and cystic changes

39
Q

what is tha management of bronchopulmonary displasia

A

reduce o2 conc on CPAP>O2 therapy>nothing over the course of months

short corse of corticosteriods

40
Q

what do long courses of corticosteroids in infants cause (when treating bronchopulmonary displasia )

A

CP

neurodevelopmental delay

41
Q

why is pertusis + RSV dangerous for kids with bronchopulmonary displasia

A

severe disease causing: pulmonary HTN and resp failure

often requiring ICU

42
Q

what type of conjunctivtis is normal in infants

A

sticky eyes but clear discharge with no redness

washing with saline is all requried

43
Q

what is abnormal conjunctivitis

A

red eyes with purulent discharge

44
Q

what pathogen usually causes conjuntivitis in neonates

A

staph or strep

45
Q

what is the treatement for staph or step conjunctivitis

A

neomycin eye drops

46
Q

what are signs of a ghonnococcal eye infection

A

within 48 hrs of birth

red eyes and purlulent discharge

47
Q

what must you do if you suspect a ? ghonnococcal conjunctivitis

A

gram stain and swab

blood cultures

48
Q

what is the management of gonnococcal conjunctivitis

A

cefalexin

penicinnin IV

49
Q

what is the presentation of chlamydia conjuntivitis

A

eye swelling!

purulent discharge

can present upto 2 w post birth

50
Q

what is the treatement for chlamydia conjunctivitis

A

erythromycin x2 weeks

51
Q

how is listeria transmitted

A

listeria myogenes i stransmitted via foods like unpasteurised chese or undercooked paultry

52
Q

what is maternal presentation of listeria

A

flu like

53
Q

what are consequenses of listeria infections to baby

A

spontaneous abortion

prem baby

fetal / neonatal sepsis

54
Q

what is the just born presentation of listeria

A

meconium stained liquor

rash

septicemia + meningitis (although this can have late onset)

55
Q

how do you treat listeria

A

ampicillin + gentaycin

56
Q

what is a PDA

A

a left to right shunt in prem babies as ductus rteriosis hasnt closed yet

57
Q

what is the presentation of a PDA

A

mainly asymptomatic but:

apnoea

bradycardia

cynosis

HF if severe

58
Q

what are the cardiac signs of a PDA

A

Bounding pulse

systolic murmur

59
Q

what is used to investigate a PDA

A

an echo

60
Q

how would you manage a PDA

A

prostaglandin synthase inhibitors = indomatacin or ibruprofen

surgery

61
Q

what causes HIE to occur

A

compramised cardiac function or decreased perfusion to brain causing barin injury

62
Q

what can trigger the events leading to HIE

A

prolonged contractions

placental abruption

umbillical cord compression

shoulder dystocia

maternal hypotension/hypertension

IUGR

failure to breathe at birth

63
Q

what is the presentation of HIE

A

must be within 48hrs of birth!!

mild=

irritable, hyperventilative, staring of eyes

mod =

fluctuating hyper + hypotonia. May have seizures

severe =

no response to pain, fluctuating tone, multiorgan failure, seizures

64
Q

what is the management of HIE

A

resp sopport

+/- anticinvulstants

EEG

fluid restriction

inotrope (digoxin)

hypoglycaemia support

hypocalcaemia support

manage hypothermia

65
Q

what is retinopathyof immaturity

A

vasular proloferation causinf retinal detachement

66
Q

what are Rf for retinopathy of prematurity

A

high o2 therapy

low birth weight (1500g)

prem (<32)

and if under 28 weeks theres risk of bilaterap retinopathy of prematurity

67
Q

what is the management of at risk patients of retinopathy of prematurity

A

weekly fundoscopy

lazer surgery

68
Q

what is necrotising enterocolitis

A

bacterial invasion of ischemic bowel wall upon bowel death

69
Q

how does necrotising enterocolitis present

A

feeding intolerence

abdo pain and distension

shiny skin on abdomen

bloody stools

bile stained vomit

shock

70
Q

what investigations are used in necrotising enterocolitis

A

x ray

transillumination of abdomen

71
Q

what findings on Xray would there be for necrotising enterocolitis

A

distended bowel loops

thickened bowel walls

intermural gas

gas under duaphragm and in billary tree

72
Q

how do you manage necrotising enterocolitis

A

stop feeds

parenteral nutrition

abx

ventilation

surgery

73
Q

is an infant has necrotising enterocolitis what are they at risk of getting in later ife

A

strictures and malabsorbtion

74
Q

what are the types of cleft lip and pallette

A

unilateral]bilateral

75
Q

what is the pathophysiology of cleft lip/pallette

A

failure of fusion of frontonasal + maxillary process as well as failure to fuse palatine process and nasal septum

76
Q

what causes cleft lip/pallette

A

folic acid deficiency

chromosomal

maternal anticonvulstant therpay

77
Q

what is the management of cleft lip/pallette

A

surgery erly in life

78
Q

describe caput succedaneum

A

bruising of presenting part of baby

79
Q

describe cephalohaematoma

A

bleeding below periosteum

usually on parietal bone

80
Q

when can a chingon ocur

A

ventrose delivery

81
Q

what can scalp electrodes do to baby

A

cause abrasions

82
Q

why would a brachial paulsey occur

A

breech

shoulder dystocia

83
Q

what nerve does erbs paulsey affect

A

C5+6

‘waiters arm’

84
Q

why wuld a facial nerve pasley occur

A

compression during birth

85
Q

what may you need to help manage facial nerve palsey

A

hydrating eye drops

mathylcellulose

86
Q

when do palseys usually reverse by

A

2-3 months

87
Q
A
88
Q
A

Phase 3a (22 decks)

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