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Paediatrics > Neonatology > Flashcards

Neonatology Flashcards

1
Q

When does the CVS start developing ?

A

Third week (heart starts beating at the beginning of the fourth week)

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2
Q

Describe how the foetal circulation works

A
  • Oxygenated blood via the umbilical vein: ductus venosus
  • Some blood via foramen ovale to left atrium - left ventricle - aorta
  • Some blood to right ventricle to pulmonary artery
  • Patent ductus arteriosus from PA to Ao
  • Saturation SaO2 in foetal body is 60-70%
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3
Q

What is the function of ductus arteriosus?

A
  • Protects lungs against circulatory overload
  • Allow the right ventricle to strengthen
  • Carries low oxygen saturated blood
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4
Q

What is the ductus venosus?

A

A foetal blood vessels connecting the umbilical vein to the IVC (blood flow regulated via sphincter) which carries mostly oxygenated blood

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5
Q

What happens to the foetal circulation after birth?

A
  • Ductus arteriosus becomes a ligament
  • Foramen ovale closes and leaves a depression
  • Ductus venosus becomes a ligament
  • Umbilical vein becomes a ligament
  • Umbilical arteries become ligaments
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6
Q

What are the normal signs of a full term newborn?

A
  • HR: 120-160 bpm
  • RR: 30-60/min
  • BP 1hr age: systolic is 70
  • BP after 1 day: systolic is 70 +/- 9
  • BP after 3 days: systolic is 77 +/- 12
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7
Q

How do babies thermoregulate?

A
  • Maternal thermoregulation in the womb
  • Newborn babies lack shivering thermo genesis thus needs a metabolic production of the heat
  • Brown fat well innervated by symp. neurons
  • Cold stress leads to lipolysis and heat production
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8
Q

How can babies lose heat?

A
  • Radiation
  • Convection: heat loss by moving air
  • Evaporation: we are born in water
  • Conduction: heat loss to surface on which the baby lies
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9
Q

How can a newborn baby’s breathing be assessed?

A
  • Blood gas determination
  • PaCO2 5-6 kPa and PaO2 8-12 kPa
  • Transcutaneous pCO2/O2 measurement
  • Capnography
  • Minute ventilation
  • Flow volume loop
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10
Q

When is jaundice in a neonate physiological?

A
  • Appears on day 2-3

- Disappears within 7-10 days in term infants and up to 21 days in premature infants

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11
Q

How can jaundice be treated?

A
  • Phototherapy

- Exchange transfusion

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12
Q

How does fluid change in a newborn?

A
  • Weight loss up to 10% is normal: shift of interstitial fluid to intravascular and diuresis
  • It is normal not to pass urine for the first 24hrs
  • Slower GFR
  • Increased insensible water loss
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13
Q

At what weight is a baby born too small?

A

2500g

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14
Q

What are the causes of babies being small for their dates?

A
  • Maternal: pre-eclampsia
  • Foetal: chromosomal, infection
  • Placental: placental abruption
  • Twin pregnancy
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15
Q

What are the common problems for a baby who is born too small for their dates?

A
  • Perinatal hypoxia
  • Hypoglycaemia
  • Hypothermia
  • Polycythaemia
  • Thrombocytopenia
  • GI problems (feeds, NEC)
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16
Q

What are the long term problems for a baby who is born too small for their dates?

A
  • Hypertension
  • Reduced growth
  • Obesity
  • Ischaemic heart disease
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17
Q

When is a baby classed as preterm?

A
  • Preterm = <37 weeks

- Extremely preterm = <28 weeks

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18
Q

What can happen to a preterm baby’s respiratory system and how can it be managed?

A
  • RDS
  • Prevention: antenatal steroids
  • Early treatment: surfactant
  • Early extubation: N-CPAP and minimal ventilation
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19
Q

What are the potential consequences of mechanical ventilation in preterm babies?

A
  • BPD/CLD
  • Overstretch by volu-baro-trauma
  • Atelectasis
  • Infection via ETT
  • O2 toxicity
  • Inflamm. changes
  • Tissue repair: scarring
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20
Q

How can BPD/CLD be treated?

A
  • Patience
  • Nutrition and growth
  • Steroids
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21
Q

What are the minor respiratory problems that can occur in preterm babies and how can they be treated?

A
  • Apnoea
  • Irregular breathing
  • Desaturations
  • Caffeine and N-CPAP
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22
Q

What can happen in the brain of a preterm baby?-

A
  • Intraventricular haemorrhage

- Peri-ventricular leucomalacia (poorly developed white matter around the ventricles

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23
Q

How can IVH be managed in preterm babies?

A
  • Prevention: antenatal steroids

- Treatment: symptomatic and ?drainage

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24
Q

What are the consequences of PDA?

A
  • Lung oedema and systemic ischaemia
  • Worsening of resp symptoms
  • Retention of fluids: low renal perfusion
  • GI ischaemia: necrotising entero-colitis
25
Q

What is NEC and how is it treated?

A
  • Ischaemic and inflammatory changes
  • Necrosis of the bowel
  • Surgical intervention is often required
  • Conservative: antibiotics and parental nutrition
26
Q

What are the nutritional requirements of a preterm baby?

A
  • Enormous requirements

- Patients often triple their size during hospital stay

27
Q

What are the risk factors for sepsis in term babies?

A
  • PROM (premature rupture of membranes
  • Maternal pyrexia
  • Maternal Group B Strep carriage
28
Q

How is presumed sepsis managed in term babies?

A
  • Admit to NNU
  • Partial septic screen (FBC, CRP, cultures) and blood gas
  • Consider CX/LP
  • 1st line: IV penicillin and gentamicin
  • 2nd line: IV vancomycin and gentamicin
  • Add metronidazole if surgical/abdo concerns
  • Fluid management and treat acidosis
  • Monitor vital signs and support resp and CVS systems as required
29
Q

Which organisms commonly cause neonatal sepsis?

A
  • Group B Strep
  • E coli
  • Listeria
  • Coagneg staph (lines in situ
  • H influenzae
30
Q

What are the complications of Group B Strep sepsis?

A
  • Meningitis
  • DIC
  • Pneumonia
  • Respiratory collapse
  • Hypotension
  • Shock
31
Q

What are the potential consequences of congenital infections?

A
  • IUGR
  • Brain calcifications
  • Neurodevelopmental delay
  • Visual impairment
  • Recurrent infections
  • Microcephaly
  • Deafness
  • Heart defects: cardiomegaly or PDA
  • Bone abnormalities
  • Anaemia, neutropenia and thrombocytopenia
  • Pneumonitis
32
Q

What are the features of transient tachypnoea of the newborn (TTN)?

A
  • Self limiting
  • Presents within 1st few hours of life
  • Grunting, tachypnoea, oxygen requirement and normal gases
  • Delay in clearance of foetal lung fluids
33
Q

How can TTN be managed?

A
  • Supportive
  • Antibiotics
  • Fluids
  • O2
  • Airway support
34
Q

What are the risk factors for meconium aspiration?

A
  • Post dates
  • Maternal diabetes
  • Maternal hypertension
  • Difficult labour
35
Q

What are the symptoms of meconium aspiration?

A
  • Cyanosis
  • Increased work of breathing
  • Grunting
  • Apnoea
  • Floppiness
36
Q

How can meconium aspiration be investigated?

A
  • Blood gas
  • Sepsis screen
  • CXR
37
Q

How can meconium aspiration be treated?

A
  • Suction below cords
  • Airway support: intubation and ventilation
  • Fluids and IV antibiotics
  • Surfactant
  • NO or ECMO
38
Q

Which investigations should be done for the “blue baby”?

A
  • History and exam
  • Sepsis screen
  • Blood gas and blood glucose
  • CXR
  • Pulse oximetry
  • ECG and ECHO
  • (Hyperoxia test - 100% oxygen for ten minutes to see if it improves their blood gas)
39
Q

What are the differentials for a blue baby?

A
  • TGA
  • Tetralogy of Fallot
  • TAPVD
  • Hypoplastic left heart syndrome
  • Tricuspid atresia
  • Truncus arteriosus
  • Pulmonary atresia
40
Q

How can hypoglycaemia be managed in neonates?

A
  • Possible admission to NNU
  • Enteral feed is possible
  • Monitor blood glucose
  • Start IV 10% glucose
  • Increase fluids
  • Increase glucose conc. (needs central IV access)
  • Glucagon
  • Hydrocortisone
41
Q

What are the risk factors for developing hypoglycaemia in a new born?

A
  • Gestational diabetes
  • Big babies
  • Twin to twin transfusion - IUGR
42
Q

How can hypothermia be managed in newborns?

A
  • Incubation
  • Sepsis screen and antibiotics
  • Consider thyroid function
  • Monitor blood glucose
43
Q

What are the causes of birth asphyxia?

A
  • Placental problem
  • Long, difficult delivery
  • Umbilical cord prolapse
  • Infection
  • Neonatal airway problem
  • Neonatal anaemia
44
Q

Describe the stages of birth asphyxia

A
  • 1st: cell damage occurs (within minutes without O2)

- 2nd: reperfusion injury due to toxin release (days-weeks)

45
Q

How can hypoxic ischaemic encephalopathy be managed

A
  • Supportive
  • Fluid restriction
  • Monitor for renal and liver failure
  • Resp and CVS support
  • Treat seizures
  • Therapeutic hypothermia
46
Q

What are the causes of failure to pass stool in newborns?

A
  • Constipation
  • Large bowel atresia
  • Imperforate anus +/- anus
  • Hirschsprungs disease
  • Meconium ileus
47
Q

How does a diaphragmatic hernia present and how can it be managed?

A
  • Males>females
  • Can be syndromic
  • Usually pulmonary hypoplasia
  • Intubation, resp support, surgery and ECMO
48
Q

What is neonatal abstinence syndrome?

A

-Withdrawal from an addictive substance taken by the mother during pregnancy (opioids, BZDs, cocaine, amphetamines etc.)

49
Q

How can neonatal abstinence syndrome be diagnosed and monitored?

A
  • Finnegan scores
  • Urine toxicology
  • Maternal comorbidity
  • Social and discharge planning
50
Q

How can neonatal abstinence syndrome be treated?

A
  • Comfort e.g. swaddling
  • Morphine
  • Phenobarbitone
51
Q

What investigation might you do in a baby with plethora?

A

FBC

52
Q

What are the three components of the energy triangle?

A
  • Pink
  • Warm
  • Sweet
53
Q

What are the symptoms of hypoglycaemia in a baby?

A
  • Jitteriness
  • Temp instability
  • Lethargy
  • Hypotonia
  • Apnoea and irregular respirations
  • Poor sucking/feeding
  • Vomiting
  • High pitched or weak cry
  • Seizures
  • Can be asymptomatic
54
Q

Which areas should be assessed for retraction in a baby

A
  • Substernal
  • Subcostal
  • Intercostal
  • Suprasternal
55
Q

Which issues are associated with cleft lip/palate?

A
  • Feeding issues
  • Airway problems
  • Associated anomalies: need hearing screen, ECHO and remember genetic abnormalities
56
Q

Which conditions can be picked up on red reflexes of the eye?

A
  • Cataracts

- Retinoblastoma

57
Q

Which abnormality is associated with spinal dimples?

A

Spina bifida

58
Q

How can fixed talipes (clubfoot) be managed?

A
  • Vigorous manipulation
  • Strapping
  • Casting
  • Surgery

Paediatrics (17 decks)

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