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Paediatrics > Neonatology > Flashcards

Neonatology Flashcards

1
Q

What are the normal vital signs for a full term newborn?

A

Heart rate- 120-160bpm
Resp rate- 30-60 breaths per minute
Blood pressure- 70/44, increases from 1 hour after birth

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2
Q

How can a newborn’s breathing be assessed?

A 
Blood gas determination
PaCO2 5-6 kPa, PaO2 8-12 kPa
Trans-cutaneous pCO2/O2 measurement
Capnography
Tidal volume 4-6 ml/kg
Minute ventilation: 
Tidal Volume ml/kg x respiratory rate
Flow-volume loop.
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3
Q

What is physiological jaundice in newborns?

A

Appears on Day of life (DOL) 2-3.

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

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4
Q

What is the threshold for treatment in jaundice in newborns?

A

250 bilirubin from 3 days old (less if younger) for phototherapy
350 bilirubin from 3 days old (less if younger) for exchange transfusion

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5
Q

What is the cause of weight loss in the first few days of life?

A

Shift of interstitial fluid to intravascular
Diuresis
It is normal not to pass urine for the first 24 hrs

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6
Q

What are the complications of small babies?

A 
Perinatal Hypoxia
Hypoglycaemia
Hypothermia
Polycythaemia
Thrombocytopenia
Hypoglycaemia
Gastrointestinal problems
Hypertension
Reduced growth
Obesity
Ischemic heart disease
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7
Q

What are the parameters for prematurity and birth weight?

A 
Preterm<37w
Extremely preterm <28w
Low b/w	<2500g
Very low b/w<1500g
Extremely low b/w<1000g
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8
Q

What is the management of acute respiratory distress syndrome?

A

Give Mum dexamethasone
Get surfactant to lungs by CPAP with catheter, ET tube if need to ventilate
Give caffeine to stimulate breathing center when trying to get off ventilation

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9
Q

What is bronchopulmonary dysplasia?

A

Scarring of the lung tissue on X-ray, caused by overstretch or atelectasis-collapse of the lungs
Oxygen has free radicals which are toxic to the tissue then see inflammatory changes (raised WCC, oedema)
Scarring makes the lungs stiff and cant breathe properly-problems later in life
Use dexamethasone if babies still ventilated, need to give these babies more calories as will be using lots of energy trying to breathe

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10
Q

What is the definition of apnoea and what is the management?

A

Not breathing for more than 20 seconds

Caffeine and CPAP

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11
Q

What is the management of intraventricular haemorrhage?

A

Prevent with steroids

Treat with drainage and manage symptoms

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12
Q

What is NEC?

A

Necrotising enterocolitis
Develops in first few weeks of life (round 6 weeks)
Distended abdomen. Oedema, erythema, shiny
On X-ray- air that is produced by the bacteria
Ischemic and inflammatory changes
Necrosis of bowel
Surgical intervention is often required
Conservative management is sometimes possible antibiotics and parenteral nutrition

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13
Q

What is the energy traingle

A

It encompasses the close relationship between hypoglycaemia, hypothermia and hypoxia in a neonate

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14
Q

What can be a cause of plethora?

A

Polycythaemia

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15
Q

What is erythema toxicum?

A 
Maculo-papular rash
30 – 70% of normal term neonates.
Very rare in the pre-term. 
Rash fades by end of the first week
No treatment needed
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16
Q

What are Mongolian blue spots

A

Blue-grey pigmentations
Often lower back and buttocks
Accumulation of melanocytes.
Common in races with pigmented skin

17
Q

What are stork marks?

A

This is a very common flat pink lesion, present at
birth. It is usually located on the forehead, eyelids,
occiput, neck or midline of the back. It may
be V-shaped on the forehead/occiput. The lesions are not pathological so there is no active management needed.

18
Q

What babies are at risk of hypoglycaemia at birth?

A 
Limited glucose supply
-Premature babies
-Perinatal stress
Hyperinsulinism
-Infants of diabetic mothers
Increased glucose utilisation
-Small and large for gestational age
-Hypothermia
-Sepsis
19
Q

What are the symptoms of hypoglycaemia in a neonate?

A 
Jitteriness
Hypothermia
Temperature instability
Lethargy
Hypotonia
Apnoea, irregular respirations
Poor suck / feeding
Vomiting
High pitched or weak cry
Seizures
Asymptomatic
20
Q

What is hypoglycaemia defined as in the neonate and what can affect the bedside reading?

A

Hypoglycaemia defined as blood sugar <2.6mmol/l

Bedside testing can be inaccurate:

  • At low or high levels
  • When there is poor perfusion
  • When there is polycythaemia
21
Q

What babies are at risk of hypothermia?

A

Low birth weight

Babies requiring prolonged resuscitation

22
Q

How can cold stress be reduced in resuscitation?

A 
Dry quickly
Remove wet linens
Use warm towels/blankets
Provide radiant warmer heat
Use heated/humidified oxygen
23
Q

In what cases of tongue ties should a frenotomy be performed?

A

Restriction of tongue protrusion beyond the alveolar margins or heavy grooving of tip of tongue and/or feeding is affected

24
Q

What areas in a newborn should be looked at for retraction in respiratory distress?

A

Subcostal
Intercostal
Substernal
Suprasternal

25
Q

What are complications of cleft lip and palate?

A 
Feeding issues
-Special bottles and teats
-Can still attempt breast feeding 
Airway problems
Associated anomalies
-Need hearing screen
-Need cardiac echo
-Remember trisomies
26
Q

What are the risk factors for meconium aspiration?

A

Post dates (aged placenta)
Maternal diabetes
Maternal hypertension
Difficult labour

27
Q

What is the presentation and investigations of meconium aspiration?

A

Cyanosis, increased work of breathing, grunting, apnoea, floppiness

Blood gas, septic screen, CXR

28
Q

What is seen on Chest X-ray in meconium aspiration?

A

There is hyperinflation of the lungs, flattened diaphragm and widespread patchy areas of collapse evident in coarse irregular densities with areas of over inflation.

29
Q

What is the management of meconium aspiration?

A 
Suction below cords
Give surfactant
Airway support
Fluids
IV antibiotics
NO and ECMO
Some develop into pulmonary hypertension
30
Q

What are some causes of failure to pass meconium?

A 
Constipation
Large bowel atresia
Imperforate anus
\+/- fistula
Hirschsprungs disease
Meconium ileus -think cystic fibrosis

Paediatrics (15 decks)

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