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My Child Health > Neonatology > Flashcards

Neonatology Flashcards

1
Q

What are the ways to get DNA from a baby?

A
  • chorionic villus biopsy to get placenta

- amniocentesis to get skin/urine cells

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2
Q

What does non-invasive prenatal testing include?

A
  • sex determination

- trisomy testing

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3
Q

How can trisomy 21 be detected non-invasively?

A

there will be an excess of chromosome 21 in the mother’s blood serum

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4
Q

What is trisomy 18?

A

Edward’s syndrome

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5
Q

What can be seen with invasive genetic testing?

A
  • chromosome abnormality with chromosome microarray

- single gene changes by PCR and next gen. sequencing

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6
Q

What are the + and - of chromosome microarray?

A

+ high resolution
+ easy
+ rapid
- may be incidental findings leading to ethical decisions about whether to tell parents or not

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7
Q

What are the characteristics of a floppy baby?

A
  • lack of head control
  • increased ROM
  • breathing difficulties
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8
Q

What are the functions of the placenta?

A
  • Fetal homeostasis
  • Gas exchange
  • Nutrient transport
  • Waste product transport
  • Acid base balance
  • Hormone production
  • Transport of IgG
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9
Q

What are the main differences in the foetal circulation to an adult’s?

A
  • ductus venosus
  • foramen ovale
  • ductus arteriosus
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10
Q

What is the ductus venosus?

A

from placenta the ox blood goes through the liver through the ductus venosus into inferior vena cava

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11
Q

What is the foramen ovale?

A

blood from the right atrium moves through this hole and into the aorta

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12
Q

What is the ductus arteriosus?

A
  • a small amount of blood enters the RV and goes into the lungs
  • this is further reduced by the ductus arteriosus which moves blood back into the aorta
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13
Q

How much of a foetus’ blood output goes to its lungs?

A

only 7% and this deoxygenated blood mixes in with the rest so the blood is very deoxygenated when it reaches the mother

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14
Q

What are the main things that happen in the 3rd trimester to prepare the baby for birth?

A
  • Surfactant production (from type 2 pneumocytes in the alveoli)
  • Accumulation of glycogen in the liver, muscle and heart
  • Accumulation of brown fat between the scapulae and around the internal organs (insulating fat)
  • Accumulation of subcutaneous fat
  • Babies inhale and swallow amniotic fluid to help the lungs to grow
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15
Q

What happens biochemically at the onset of labour?

A
  • increased catecholamines/cortisol

- synthesis of lung fluid stops

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16
Q

How long after birth until the cord is clamped?

A

around 1 minute

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17
Q

What are the changes that occur after the cord is clamped?

A
  • pulmonary vascular resistance drops
  • systemic vascular resistance rises
  • oxygen tension rises
  • circulating prostaglandins drop
  • ducts constrict and foramen ovale closes
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18
Q

What happens to the FO, DA and DV?

A

foramen ovale= shuts
DA= ligamentum arteriosus
DV= ligamentum teres

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19
Q

How can persistent pulmonary hypertension of the newborn be tested for?

A
  • pre and post ductal sats
  • blood before DA will have a higher saturation
  • sats monitors on hand and foot
  • more than 3% different means a problem
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20
Q

What is the management of PPHN?

A 
ventilation
oxygen
nitric oxide
sedation
inotropes
ECLS/ECMO
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21
Q

What is the aims of management of PPHN?

A

vasodilate the pulmonary vasculature to reduce the pressure in the lungs

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22
Q

What type of babies is transient tachypnoea common in?

A

large healthy babies that are born by section

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23
Q

What is the ideal temperature for a baby?

A

36.5-37.4 degrees

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24
Q

What is acrocyanosis?

A

this is longer term blueness of the hands and feet of a newborn which is normal

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25
Q

What biochemical levels may drop in a newborn baby?

A
  • insulin as there is not much milk production in the mother until day 5
  • there are ketones for backup
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26
Q

What are the babies that are most at risk of hypoglycaemia?

A
  • increased energy demands due to sickness
  • low glycogen stores due to prematurity
  • inappropriate insulin to glucagon ratio due to GDM
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27
Q

What drug risks hypoglycaemia of the infant if the mother takes it during pregnancy?

A

beta blockers

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28
Q

What are the benefits of breastfeeding for the mother?

A
  • reduced risk of breast cancer

- prevention of post-natal depression

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29
Q

What is the affinity of foetal haemoglobin like?

A

high affinity for oxygen so grabs it well but doesn’t let it go very well hence the need for adult haemoglobin (physiological anaemia in the gap between types)

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30
Q

What causes the shift in the curve for haemoglobin in babies?

A

an increase in 2,3 BPG which shifts the curve to the right

31
Q

What are jaundice babies treated with?

A

phototherapy (blue light causes baby to pee out bilirubin) and very occasionally they need exchange transfusion

32
Q

What is normal baby weight?

A

2.5-4kg

33
Q

Why are babies given vitamin K?

A

they are given this IM to prevent haemorrhage disease of the newborn which is spontaneous bleeding

34
Q

What are some tests that are done on newborns?

A
  • TSH for thyroid function
  • cystic fibrosis
  • hip exam
35
Q

What is looked for in the head, eyes and ears of babies?

A
  • Head: circumference, cup succedaneum (more superficial), cephalhaematoma (deeper, stop at suture lines and are just above periosteum)
  • Eyes: conjunctival haemorrhage, red reflex for cataracts and iris abnormality
  • Ears: postion, ear canal, pits, Fhx of hearing loss
36
Q

What is looked for in the mouth, rest and cardio systems of babies?

A
  • Mouth: philtrum (smooth is alcohol), tongue tie, palate, teeth (need removed), Epstein’s pearls and sucking reflex
  • Resp: nasal flaring, grunting, should be <60 breaths per minute
  • Cardio: sats, pulses, apex, thrills and heaves, heart sounds (eg murmur from pulmonary stenosis of Tetralogy of Fallot)
37
Q

What is looked for in the abdominal, genitourinary, MSK and skin of babies?

A
  • Abdo: distension, hernias, bile vomiting, anus and gastroschisis
  • GU: undescended testes
  • MSK: spine for spina bifida, hip exams for DDH
  • Dermatology: strawberry birthmarks, Mongolian blue spots
38
Q

What is included in the Apgar score?

A

-Appearance
-Pulse
-Grimace
-Activity
-Respiration
2 for each, 8 or over is normal

39
Q

How much blood does a baby have?

A

300ml which is can of coke amount so hypovolaemia is common

40
Q

What are the main bacteria that babies tend to be infected with?

A
  • group B strep
  • E.coli
  • S.aureus
  • S.epidermidis
41
Q

What are the main viruses that babies tend to be infected with?

A
  • enteroviruses
  • paroviruses
  • herpes
  • cytomegalovirus
42
Q

What are the main congenital respiratory conditions of newborns?

A

tracheo-oesophageal fistula and diaphragmatic hernia

43
Q

What are the causes of HF in newborns?

A

HF with Hydrops fetalis can be caused by Rhesus disease (mother is anaemic) or chromosomal causes

44
Q

What are the weeks for pre, post and term babies?

A

up to 37 weeks is preterm
37-42 weeks is term
above 42 weeks is post term

45
Q

What are the levels of preterm?

A

extreme preterm is 23-27
very preterm is up to 32
preterm is up to 37

46
Q

What are the risk factors for early death of a child?

A
  • Preterm delivery
  • Low birth weight
  • Maternal age
  • Smoking
  • Postcode/poverty
47
Q

What are the risk factors for preterm babies?

A
  • Back to back pregnancies
  • IVF
  • Smoking, alcohol and drugs
  • Poor nutrition
  • Multiple preterm babies
48
Q

Why do babies get hypothermic?

A
  • low metabolic rate
  • minimal muscular activity
  • fat insulation is negligible
  • high ratio of SA to mass
49
Q

How is hypothermia treated in babies?

A
  • cosy bags
  • skin to skin
  • transwarmer mattress
  • prewarmed incubator
50
Q

What are some common respiratory disease in preterm babies?

A
  • respiratory distress syndrome
  • apnoea of prematurity
  • bronchopulmonary dysplasia
51
Q

What is RDS and how does it present?

A
  • RDS is lack of surfactant and undeveloped lungs
  • symptoms are tachypnoea, increased RR, grunting, intercostal recession, nasal flaring, cyanosis
  • this will worsen over minutes to hours
52
Q

What is the treatment for RDS?

A
  • maternal steroid
  • surfactant
  • ventilation
53
Q

What is necrotising enterocolitis?

A

gut bacteria moves into the blood and can progress to sepsis

54
Q

What can cause low baby birth weight?

A
  • smoking (affects placental function)
  • malnutrition
  • valium
55
Q

What is the best blood sugar for a baby?

A

above 2.6

56
Q

What could cause low blood sugar in a baby?

A
  • not being fed
  • coldness
  • mums with GDM
  • mums that take beta blockers
  • infection
57
Q

What are the signs of hypoglycaemia in a baby?

A 
Low temperature
Sleepiness
Seizures
Jitteriness 
Poor feeding
58
Q

What causes physiological jaundice in a newborn?

A

the old foetal haemoglobin is broken down and this makes bilirubin but the liver can’t handle this so jaundice at 2-5 days

59
Q

What are some other causes of jaundice in a newborn baby?

A
  • infection
  • blood group incompatibility
  • placental insufficiency (baby makes more red cells so higher haemoglobin so more breakdown)
  • trauma so bruising
  • dehydration
  • preterm
60
Q

When would a baby get Hep B?

A

normally as part of injection regime but if there is IVDU in the family then this would happen earlier

61
Q

What are the causes of tachypnoea in the newborn?

A 
Infection
RDS
Withdrawal 
Pneumothorax 
Diaphragmatic hernia 
NAS
Cardiac problems 
Aspiration
62
Q

Why is breastfeeding good for NAS babies?

A

it helps them to come down off the drug as there is some drug in the breastmilk

63
Q

What are the treatments for babies with NAS?

A
  • Cuddle them, give them a pacifier, put them in a rockable pram, play music
  • oromorph or phenobarbital
64
Q

What percentage of weight loss is ok for a baby?

A

up to 10%

65
Q

What does the baby blood spot test screen for?

A

CF
Sickle cell
Congenital hyperthyroidism

66
Q

What is prolonged jaundice in a baby?

A

beyond the first 14 days

67
Q

What is a green tinged jaundice baby?

A

obstructive jaundice from TPN

68
Q

What are the three ways that a baby can have an obstruction somewhere?

A
  • something in the lumen
  • something pushing from the outside
  • something in the wall
69
Q

What is a soap bubble sign on an XR?

A

obstruction in the lumen of the bowel

70
Q

What can cystic fibrosis present as outside of the lungs?

A

a bowel problem which is quite common and can cause a meconium ileum in a neonate

71
Q

What is an atresia?

A

a dead-end in the gut

72
Q

What is laddering on an XR a sign of?

A

obstruction

73
Q

What is the colour of bile stained vomiting and what could be causing it?

A
  • mossy green like fairy liquid (not yellow like how it is in the liver)
  • could be malrotation causing a volvulus with top left and bottom right of bowel
  • needs an upper GI contrast fast or the bowel will infarct

My Child Health (5 decks)

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