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CP2 PAEDS > Neonatology > Flashcards

Neonatology Flashcards

1
Q

Define stillborn

A

Foetus w/ no signs of life > 24 weeks

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2
Q

Define neonate

A

Infant < 28 days after term date

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3
Q

Define preterm

A

Gestation <37w

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4
Q

Define post term

A

> 42 weeks

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5
Q

Incidence VSD

A

30%

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6
Q

Incidence persistent arterial duct

A

12%

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7
Q

Incidence ASD

A

7%

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8
Q

L-R shunts overall Sx

A

Breathless

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9
Q

R-L shunts overall Sx

A

Blue

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10
Q

Common mixing overall Sx

A

Breathless + blue

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11
Q

Outflow obstruction in well child overarll Sx

A

Asymp + murmur

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12
Q

E.g.s of outflow obstruction in well child (2)

A

Pulmonary stenosis

Aortic stenosis

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13
Q

Outflow obstruction in sick neonate overall Sx

A

Collapsed w/ shock

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14
Q

E.g of outflow obstruction in sick neonate

A

Coarctation of aorta

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15
Q

R-L Shunts e.g.s (2)

A

ToF

Transposition of great aa

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16
Q

Common mixing e.g.

A

Atrioventricular septal defect

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17
Q

Which are the cyanotic lesions (3)

A

ToF
ToGV
AVSD

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18
Q

Which are the acyanotic lesions (5)

A 
VSD
ASD
PDA
PS
AS
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19
Q

Common heart lesions associated w/ Downs (2)

A

AVSD

VSD

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20
Q

Common heart lesions associated w/ Turners (2)

A

Aortic valve stenosis

Coarctation of aorta

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21
Q

What does a transplacental infection transmission lead to (5)

A 
Still birth/miscarriage 
IUGR
Microcephaly 
Hydrocephalus 
HSmegaly
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22
Q

When is risk of transplacental infection highest?

A

In 1st 16w pregnancy

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23
Q

When does early onset sepsis occur?

A

<48hrs after birth

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24
Q

Why does early onset sepsis occur?

A

Bacteria from birth canal –> amniotic fluid

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25
What 2 organisms tend to be causative in early onset sepsis?
E.coli | GBS
26
What is a common illness associated with early onset sepsis?
Pneumonia
27
What septic screen should be undertaken if you suspect early onset sepsis?
Urinalysis FBC CXR LP
28
Mx early onset sepsis
ABx IV amoxicillin/ gentamicin
29
When does late onset sepsis occur?
>48hrs after birth
30
Most common cause late onset sepsis
Staph epidermis
31
Mx late onset sepsis
Fluclox/gentamicin
32
Mortality neonatal meningitis
20-50%
33
Signs neonatal meningitis
Sepsis Bulging fontanelle Hyperextension of neck + back
34
Mx neonatal meningitis
Amoxicillin + cefotaxime
35
Signs early infection from Group B streptococcus
Pneumonia + resp distress -->meningitis + sepsis
36
What does the severity of early GBS depend on
Duration of infection in utero
37
Mortality rate early GBS
10%
38
When does late GBS occur
@ 3 months
39
What occurs in late GBS
Meningitis or osteomyelitis/septic arthritis
40
RF GBS (5)
``` Pre-term PROM Maternal fever during labour Chorioamnionitis Previously infected infant ```
41
Antenatal Mx group B strep
Prophylactic intrapartum ABx | IV Ben Pen
42
Postnatal Mx group B strep
CXR + septic screen, FBC, CRP | Broad spectrum ABx
43
RF maternal Hep B (3)
IVDU HIV Multiple sexual partners
44
If the baby is +vefor HBsAg, what must be done?
Hep B vaccine after birth
45
Which babies are at highes risk of developing chronic Hep B?
If mothers have antigens for Hbe but no antibodies
46
If a baby is at risk of developing chronic Hep B, what is the Mx?
Give Hep B IGs within 24hrs
47
What % neonates with CMV will be normal?
90%
48
What % neonates w/ CMV will have HSmegaly and petechiae --> nero problems?
5%
49
What will the remaining 5% of neonates w/ CMV develop in later life?
SNHL
50
Sx CMV in mother
Asymptomatic
51
Sx rubella in mother
``` Low grade fever Conjunctivitis Coryza Rash Arthralgia ```
52
If mother gets rubella @ 8-10w gestation, what are the effects on the foetus?
``` 90% chance of: ANHL Congenital cataracts PDA HSmegaly CP Small eyes ```
53
What is the risk of damage to foetus if rubella is contracted at 11-16w
10-20%
54
Where do you contract toxoplasmosis from?
Cat poo | Raw meat
55
If contracted in utero, what can toxoplasmosis cause?
IU death | CNS damage - hydrocephalus, calcification
56
Sx newborn w/ toxoplasmosis infection
``` LBW HSmegaly Jaundice Inflamed retina Petechiae LT neurodevelopmental issues ```
57
If untreated, what % transmission rate is it for HIV from mother --> foetus
25%
58
If untreated, what % transmission rate for HIV from mother --> foetus
<2%
59
Methods of preventing perinatal transmission (4)
ART antenatally, perinatally + postnatally (want undetectable viral load @ time delivery) Pre-labour C section if VL detectable Avoid breast feeding Active Mx labour - avoid PROM
60
Sx syphilis in neonate (9)
``` FTT Irritability Flat nose Rash - mouth/anus/genitals Water rhinitis HSmegaly Bone deformity Anaemia Meningitis ```
61
Sx neonatal chlamydia
Conjunctivitis | Peri-orbital swelling
62
What is gonorrhoea associated with in pregnancy
Choriomanionitis | Incr risk prematurity
63
Sx ophthalmia neonatorum
Purulent discharge, lid swelling, corneal haze
64
How is herpes transmitted to baby?
Infected birth canal
65
How to prevent herpes?
C-section
66
How can having herpes as a neonate --> death?
Encephalitis | Or disseminated disease
67
Causes of bilious vomiting (5)
``` Intussusception Obstruction/volvulus Malrotation Tumour Hirschprungs ```
68
Define IUGR
Asymmetrically growth restricted Less than geneitcally predetermined size Weight and abdo circumference lie on lower centile than that of head
69
Define small for gestation age
Smaller in size than normal for sex + gestational age
70
Maternal causes IUGR (8)
``` Incr maternal age HTN DM Alcohol/Dx use Smoking Renal disease Untreated coeliac Warfarin, steroids, phenytoin ```
71
Placental causes IUGR (3)
Small Cell death Pre-eclampsia
72
Foetal causes IUGR (4)
Multiple pregnancy Chromsomal abnormalities Congenital defects Infection - CMV, toxoplasmosis, rubella, syphillis
73
After birth, what is there an increased risk of if the baby was IUGR?
CV T2DM AI
74
Signs a newborn infant is in respiratory distress (5)
``` Tachypnoea >66RR Sternal + subcostal recession Nasal flaring Expiratory grunting Cyanosis if severe ```
75
What causes transient tachypnoea of the newborn?
Delay in resorption of lung fluid
76
Xray appearance transient tachypnoea
Fluid in horizontal fissure
77
How long does transient tachypnoea of the newborn take to settle?
Usually within 1 day of life
78
What is respiratory distress syndrome?
Deficiency of surfactant --> decr surface tension --> widespread alveolar collapse + poor (g) exchange
79
What is surfactant secreted by?
II pneumocytes of alveolar epithelium
80
WHo is at risk of respiratory distress syndrome?
Pre-term <28weeks
81
What should you give babies in risk of having respiratory distress syndrome?
Glucocorticoids to incr surfactant
82
PS respiratory distress syndrome (5)
``` Tachypnoea Chest wall recession - sternal/subcostal Nasal flaring Grunting Cyanosis ```
83
Ix for respiratory distress syndrome
CHXr
84
Appearance of CXR in respiratory distress syndrome
Diffuse granular appearance - ground glass | Indistinct heart border
85
Mx respiratory distress syndrome (3)
Surfactant therapy via tracheal tube O2 + CPAP Artificial ventilation
86
Factors predisposing to congenital pneumonia (3)
PROM Chorioamnionitis LBW
87
Mx congenital pneumonia
Broad spectrum ABx
88
What side is a diaphragmatic hernia usually on?
Left
89
How to detect diaphragmatic hernias
USS
90
PS diaphragmatic hernia
Failure t respond to resus/ resp distress
91
O/E diagragmatic hernia
Displaces apex beat + heart sounds to right Poor entry air into L chest Bowel sounds in chest?
92
How to diagnose diaphragmatic hernias
CXR
93
Mx diaphragmatic hernia
NG tube | Surgical repair
94
% survival rate diaphragmatic hernia
50%
95
CXR meconium aspiration
Irritant to lungs --> obstruction --> chemical pneumonitis
96
Signs meconium aspiration
Cord/fingernails green | Resp distress signs
97
Mx meconium asp if baby cries @ birth
Normal resp | So no resus
98
Mx meconium asp if baby has reduced breathing
CRAP
99
Mx meconium asp if baby not breathing
Suction meconium w/ large bore suction catheter
100
Causes of prematurity (5)
``` Pregnancy induced HTN Infection PPROM Previous pre-term baby Anatomical abnormality of cervix or uterus ```
101
Problems faced by baby born <26w
``` Resus @ borth RDS Pneumothorax APnoea Bronchopulmonary dysplasia HoTN PDA Hypothermia Metabolic imbalances Jaundice Infection NEC ROP PVLM/IVH Anemia Hernia ```
102
What is necrotising enterocolitis
Bacterial invasion of ischaemic bowel
103
Sx NEC
Distended abdo and stool bleed
104
Mortality NEC
20%
105
For who is hypoglycaemia likely for in their 1st 24hrs? (6)
``` IUGR Pre-term Mother w/diabetes Large for date Hypothermic Ill ```
106
Sx hypoglycaemia (5)
``` Irritability Apnoea Lethargy Drowsiness Seizures ```
107
What level of glucose is required for neurodevelopment
>2.6
108
Tx hypoglycaemia
Early + freq feed w/ breast link If really low - IV infusion glucose Maybe glucagon + hydrocortisone
109
What can hypothermia cause? (5)
``` Incr E consumption Hypoxia Hypoglycaemia Failure to gain weight Incr mortality ```
110
Which babies are particularly suscpetible to hypothermia (3)
Incr SA:Vol Thin skin Decr fat
111
Tx hypothermia
Incubate | Humidify air
112
When are episodes of apnoea common in LBW infants?
Under 32 weeks
113
When does bradycardia occur with apnoea?
If infant doesn't breath for 20-30s | Breathing against closed glottis
114
Mx apnoea
Physical stimulation Caffeine CPAP
115
What does retinopathy of prematurity affect?
BV at jct of vascular + non-vascular retina
116
What does vascular proliferation in retinopathy lead to?
Retinal detachment Fibrosis Blindness
117
Tx of retinopathy of prematurity?
Laser therapy | Ophthal review every week
118
Who is intraventricular haemorrhage common in?
Underweight children/neonates
119
PS intraventricular haemorrhage
``` Apnoea Lethargy Poor mm control/tone Hydrocephalus Incr ICP + bulging fontanelle ```
120
What can an intraventricular haemorrhage progress into?
Coma
121
Mx intraventricular haemorrhage
Supportive Correct acidosis, anaemia + hypotension Fl - decr ICP Ventriculoperitoneal shunt
122
If a baby is born at 28w, how long does it taken them to double their weight?
6 weeks
123
If a baby is born at term, how long does it take them to double their weight?
4/5months
124
At how many weeks is a baby mature enough to swallow milk?
35-6
125
NG feeding for less mature babies
Cont phosphate protein + Kcal + Ca + Vit D + Fe Enterally
126
Advantages of breast milk in premature babies (5)
``` Ideal nutrition for first 4-6m Life saving in LICs Decr risk GI infection (NEC) Incr mother-child relationship Decr risk diabetes, HTN, obesity ```
127
What is bronchopulmonary dysplasia?
O2 requirement at post menstrual age @36W
128
Characteristic CHX bronchopulmonary dysplasia?
Widespread opacification
129
Mx bronchopulmonary dysplasia
Wean onto CPAP
130
Neurodevelomental complications of prematurity
Cerebral palsy | Complications of blindness + deafness
131
CV changes after first breath
``` Decr pulmonary resistance x6 incr blood to lungs Decr blood to RA (b/c no placenta) LA > RA - FO closes DA closes ```
132
How is lung fluid reabsorbed @ birth?
Chest compression during birth squeezes out 1/3 | Release of adrenaline incr reabsorption
133
Within how long should a baby pass urine?
24hrs
134
Within how long should a baby pass meconium?
<48hrs
135
How long should it take for a neonate to regain its birth weight?
7-10days
136
Normal BW
3.5kg
137
Low BW
2.5kg
138
V low BW
1.5kg
139
Extremely low BW
1kg
140
Within how long of delivery should a mother attempt to breastfeed?
1hr
141
What prophylaxis must all newborns have?
Vitamin K
142
How is vitamin K administered
Single IM | or 3x PO dose
143
Why is Vit K given prophylactically?
Prevent haemorrhagic disease of newborn
144
When does haemorrhagic disease of the newborn occur?
In 1st week of life | or up to 8 weeks
145
If mild, what are the Sx of haemorrhagic disease of the newborn?
Bruising Haematemesis Melena Prolonged bleeding from umbilical stump
146
If severe, what are the Sx of haemorrhagic disease of the newborn?
Intracranial haemorrhage --> brain damage/death
147
Why is Vit K low in the newborn? (4)
Poor placental transfer Absence of Vit K prod bacteria in neonatal gut Liver immaturity Breast milk has low levels of vit K
148
Vit K regime if mother takes anticonvulsants
PO prophylaxis from 36w + IM injection
149
When should the new born exam happen?
Within 72hrs
150
When is peripheral cyanosis common?
1st day
151
Why might a baby have swollen eyes and distortion of head shape
From delivery
152
What are epstein pearls
White pears on palate
153
When is erythema toxicum common?
2-3 days
154
What is erythema toxicum
White pinpoint papules in erythematous base | On trunk
155
What is Milia?
Baby acne
156
What is caput secundum
Oedematous swelling on scalp b/c pressure against cervix
157
Cephaematoma
Subperiosteal collection of blood | After rupture of vessels betw skull + periosteum
158
When does port-wine stain occur
From birth
159
When does strawberry naevus occur?
1st month
160
What is Guthrie?
Heel prick test taken @ 5-9 days
161
What does the Guthrie test screen for? (4)
PKU Hypothyroid Haemoglobinopathies - sickle cell, B thalassaemia MCAD
162
What 3 things are noted if CF?
Serum trypsin | Incr in pancreatic duct obstruction
163
When does a hearing test occur/
Within 2 weeks of birth
164
What is EOAE testing
Earphone over ear | Sound evokes ech from cochlear if fct normal
165
Appearance of a capillary haemangioma
Pink macule on upper eye lid, mid forehard or neck distension of dermal capillaris
166
Reasons for feeding difficulties in the newborn (4)
Cleft lip/palate Premature - unable to suck/swallow Poor attachment to nipple GORD
167
What is a brachial plexus injury ?
Traction of branchial nn root
168
Who is at increased risk of a brachial plexus injury?
Breech | Shoulder dystocia
169
Features of Erbs palsy
Arm lies flat, limp Hand pronated Fingers flexed
170
Outcome brachial plexus injury
Most resolve completely | If not by 2-3months - Rx
171
What is Sticky eye
Yellow discharge from corner of eye --> crusting
172
Why does sticky eye occur?
Blockage of small tear ducts
173
Mx Sticky Eye
Bathe - sterile H2O
174
Why does Haemolytic disease of newborn occur?
Transplacental transfer maternal antibodies --> immune haemolysis of RBC in newborn
175
Causes haemolytic disease of newborn (3)
Rhesus ABO Other antibodies - Kell, Duffy
176
Antenatal presentation of Rhesus
Coombes test - presence antiD antibodies mother | USS - hydrops fetalis/polyhydramnios
177
Neonatal presentation Rhesus
Jaundice Oedema HS megaly
178
Ix Rhesus (4)
Coombs USS FBS Post natal - umbilical blood sampling
179
Mx Rhesus
O transfusion via umbilical vv if anaemia
180
What % babies w/ Rhesus = norm @ birth
50% (still monitor for late anaemia)
181
What % Rhesus babies req transfusion
25%
182
How to Tx jaundice assoc w/ Rhesus
Phototherapy
183
Mother + father blood groups for ABO incompatibility
Type A/B father | Type O mother
184
PS ABO incompatibility
Jaundice but not as sever RH
185
When does ABO incompatibility peak?
12-72hrs
186
Mx ABO incompatibility
Severe - transfusion Neonatal blood test Phototherapy
187
Prognosis ABO incompatibility
SNHL
188
Main RF for congenital abnormalities (5)
``` Maternal/paternal age Consanguinity Infections - TORCH Toxins - alcohol, smoking, mercury, Dx Dietary deficiency - folic acid, too much vit A ```
189
CHARGE
``` Coloboma of eye Heart Defect Atresia of nasal choaenae Retardation of growth Genitourinary Ear and deafness ```
190
VACTERL
``` Vertebral defects/scoliosis Anal Atresia CV abnormalities TO fistula Eosophageal atresia Renal abnormalities Limb defects ```
191
What is VACTERAL associated with
Diabetic mothers | Edwards (trisomy 18)
192
What is Trisomy 13?
Patau
193
Risk factors Patau
Female | Incr maternal age
194
PS Patau
``` LBW Congenital heart defects - Holoprosencephaly NTD Severe LD Small eyes Scalp structures Gastro/UG defect Plydactylyl ```
195
Congenital heart defects associated with Patau's (4)
ASD, VSD, PDA, dextrocardia
196
Holoprosencephaly
Defect in brain hence doesn't split into 2 halves
197
Median survival neonate with Pataus
2.5 days
198
What is Trisomy 18
Edwards
199
What % foetuses with Edwards will die?
95%
200
Prenatal features Edwards (7)
``` Polyhydramnios Oligohydramnios Small placenta Single umbilical aa Fetal distress IUGR Weak fetal activity ```
201
Postnatal features Edwards (8)
``` LBW Craniofacial abnormality Skeletal abnormalities - overlapping fingers, prominents calcaneus Heart defects GI abnormalities Urogenital - hydronephrosis Neuro - hydrocephaly, LD Pulmonary hypoplasia ```
202
Mean life expectancy Edwards
4 days
203
Anencephaly
Failure to develop most of cranium/brain
204
Prognosis Anencephaly
Still born/die @birth
205
Encephalocele
Midline skull defects --> extrusion of brain/meninges
206
Mx encephalocele
Surgical correction
207
Spina bifida occulta
Failure of fusion of vertebral arch
208
Appearance spina bifida in lumbar region
Tuft of hair, lipoma, birthmark or dermal sinus
209
Meningocele
Skin + meninges form out-pouching Cord remains in meninges PS similar to spina bifida
210
Myelomeningocele
Communication between surface + meninges
211
Complications myelomeningocele
``` Paralysis Sensory loss Mm imbalance Neuropathic bladder Scoliosis Hydrocephalus ```
212
Male - ambiguous genitalia
Hypospasias + bifid scrotum | Undescended/palpable testes
213
Female - ambiguous genitalia
Clitoral hypertrophy | Vulva + single opening
214
Ovotesticular disorder of sex development
Both XX + Y cells present in foetus hence both testes + ovarian tissue
215
What is Potters sydrome
Pressure in utero --> oligohydramnios --> urgenital abnormalities
216
When do foetal kidneys develop?
Betw 5-7w
217
When does foetus urine production start?
From 14 weeks
218
Potters syndrome PS (7)
``` Dysmorphic face - flat nose, recessed chin, low-set cartilage Pulmonary hypoplasia Anuria/oliguria Cataracts/lens prolapse CV malformations MSK - clubbed feet, malformed hands Brain abnormalities ```
219
What is HIE due to?
Significant hypoxic events immediately before/after delivery E.g. placenta problem, chord compression, shoulder dystocia, maternal HoTN, IUGR, anaemia, failure cardio-resp adaptations @ birth
220
Mild HIE (4)
Irritable Respond to excessive stimulation Hyperventilation Impaired feeding
221
Moderate HIE (3)
Tone abnormalities Can't feed Seizures
222
Severe HIE (4)
No norm/spontaneous movements Hypertonia/hypotonia fluctuation Prolonged seizures Multi-organ failure
223
Mx HIE (7)
``` Resp support EEG Seizure Tx Fl restriction Tx HoTN Monitor hypoglycaemia, electrolyte imbalance Cool child to 33/34' within 6hrs ```
224
Prognosis mild HIE
Excellent
225
Prognosis mod HIE
If full recovery by 2 weeks = excellent
226
Prognosis severe HIE
Mort 30-40% | 80% have neurodevelopmental issues
227
What is acrocyanosis and is it normal
Peripheral cyanosis around extremities is completely normal due to benign vasomotor changes --> peripheral vasoconstriction

CP2 PAEDS (18 decks)

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