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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
Q

What 2 organisms tend to be causative in early onset sepsis?

A

E.coli

GBS

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26
Q

What is a common illness associated with early onset sepsis?

A

Pneumonia

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27
Q

What septic screen should be undertaken if you suspect early onset sepsis?

A

Urinalysis
FBC
CXR
LP

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28
Q

Mx early onset sepsis

A

ABx IV amoxicillin/ gentamicin

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29
Q

When does late onset sepsis occur?

A

> 48hrs after birth

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30
Q

Most common cause late onset sepsis

A

Staph epidermis

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31
Q

Mx late onset sepsis

A

Fluclox/gentamicin

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32
Q

Mortality neonatal meningitis

A

20-50%

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33
Q

Signs neonatal meningitis

A

Sepsis
Bulging fontanelle
Hyperextension of neck + back

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34
Q

Mx neonatal meningitis

A

Amoxicillin + cefotaxime

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35
Q

Signs early infection from Group B streptococcus

A

Pneumonia + resp distress –>meningitis + sepsis

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36
Q

What does the severity of early GBS depend on

A

Duration of infection in utero

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37
Q

Mortality rate early GBS

A

10%

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38
Q

When does late GBS occur

A

@ 3 months

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39
Q

What occurs in late GBS

A

Meningitis or osteomyelitis/septic arthritis

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40
Q

RF GBS (5)

A 
Pre-term 
PROM 
Maternal fever during labour 
Chorioamnionitis 
Previously infected infant
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41
Q

Antenatal Mx group B strep

A

Prophylactic intrapartum ABx

IV Ben Pen

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42
Q

Postnatal Mx group B strep

A

CXR + septic screen, FBC, CRP

Broad spectrum ABx

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43
Q

RF maternal Hep B (3)

A

IVDU
HIV
Multiple sexual partners

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44
Q

If the baby is +vefor HBsAg, what must be done?

A

Hep B vaccine after birth

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45
Q

Which babies are at highes risk of developing chronic Hep B?

A

If mothers have antigens for Hbe but no antibodies

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46
Q

If a baby is at risk of developing chronic Hep B, what is the Mx?

A

Give Hep B IGs within 24hrs

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47
Q

What % neonates with CMV will be normal?

A

90%

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48
Q

What % neonates w/ CMV will have HSmegaly and petechiae –> nero problems?

A

5%

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49
Q

What will the remaining 5% of neonates w/ CMV develop in later life?

A

SNHL

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50
Q

Sx CMV in mother

A

Asymptomatic

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51
Q

Sx rubella in mother

A 
Low grade fever
Conjunctivitis 
Coryza 
Rash 
Arthralgia
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52
Q

If mother gets rubella @ 8-10w gestation, what are the effects on the foetus?

A 
90% chance of: 
ANHL
Congenital cataracts 
PDA
HSmegaly 
CP 
Small eyes
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53
Q

What is the risk of damage to foetus if rubella is contracted at 11-16w

A

10-20%

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54
Q

Where do you contract toxoplasmosis from?

A

Cat poo

Raw meat

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55
Q

If contracted in utero, what can toxoplasmosis cause?

A

IU death

CNS damage - hydrocephalus, calcification

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56
Q

Sx newborn w/ toxoplasmosis infection

A 
LBW
HSmegaly 
Jaundice 
Inflamed retina 
Petechiae
LT neurodevelopmental issues
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57
Q

If untreated, what % transmission rate is it for HIV from mother –> foetus

A

25%

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58
Q

If untreated, what % transmission rate for HIV from mother –> foetus

A

<2%

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59
Q

Methods of preventing perinatal transmission (4)

A

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

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60
Q

Sx syphilis in neonate (9)

A 
FTT 
Irritability 
Flat nose 
Rash - mouth/anus/genitals 
Water rhinitis 
HSmegaly 
Bone deformity 
Anaemia 
Meningitis
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61
Q

Sx neonatal chlamydia

A

Conjunctivitis

Peri-orbital swelling

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62
Q

What is gonorrhoea associated with in pregnancy

A

Choriomanionitis

Incr risk prematurity

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63
Q

Sx ophthalmia neonatorum

A

Purulent discharge, lid swelling, corneal haze

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64
Q

How is herpes transmitted to baby?

A

Infected birth canal

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65
Q

How to prevent herpes?

A

C-section

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66
Q

How can having herpes as a neonate –> death?

A

Encephalitis

Or disseminated disease

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67
Q

Causes of bilious vomiting (5)

A 
Intussusception 
Obstruction/volvulus 
Malrotation 
Tumour 
Hirschprungs
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68
Q

Define IUGR

A

Asymmetrically growth restricted
Less than geneitcally predetermined size
Weight and abdo circumference lie on lower centile than that of head

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69
Q

Define small for gestation age

A

Smaller in size than normal for sex + gestational age

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70
Q

Maternal causes IUGR (8)

A 
Incr maternal age 
HTN
DM 
Alcohol/Dx use 
Smoking 
Renal disease 
Untreated coeliac 
Warfarin, steroids, phenytoin
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71
Q

Placental causes IUGR (3)

A

Small
Cell death
Pre-eclampsia

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72
Q

Foetal causes IUGR (4)

A

Multiple pregnancy
Chromsomal abnormalities
Congenital defects
Infection - CMV, toxoplasmosis, rubella, syphillis

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73
Q

After birth, what is there an increased risk of if the baby was IUGR?

A

CV
T2DM
AI

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74
Q

Signs a newborn infant is in respiratory distress (5)

A 
Tachypnoea >66RR 
Sternal + subcostal recession
Nasal flaring 
Expiratory grunting 
Cyanosis if severe
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75
Q

What causes transient tachypnoea of the newborn?

A

Delay in resorption of lung fluid

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76
Q

Xray appearance transient tachypnoea

A

Fluid in horizontal fissure

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77
Q

How long does transient tachypnoea of the newborn take to settle?

A

Usually within 1 day of life

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78
Q

What is respiratory distress syndrome?

A

Deficiency of surfactant –> decr surface tension –> widespread alveolar collapse + poor (g) exchange

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79
Q

What is surfactant secreted by?

A

II pneumocytes of alveolar epithelium

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80
Q

WHo is at risk of respiratory distress syndrome?

A

Pre-term <28weeks

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81
Q

What should you give babies in risk of having respiratory distress syndrome?

A

Glucocorticoids to incr surfactant

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82
Q

PS respiratory distress syndrome (5)

A 
Tachypnoea 
Chest wall recession - sternal/subcostal 
Nasal flaring 
Grunting 
Cyanosis
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83
Q

Ix for respiratory distress syndrome

A

CHXr

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84
Q

Appearance of CXR in respiratory distress syndrome

A

Diffuse granular appearance - ground glass

Indistinct heart border

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85
Q

Mx respiratory distress syndrome (3)

A

Surfactant therapy via tracheal tube
O2 + CPAP
Artificial ventilation

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86
Q

Factors predisposing to congenital pneumonia (3)

A

PROM
Chorioamnionitis
LBW

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87
Q

Mx congenital pneumonia

A

Broad spectrum ABx

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88
Q

What side is a diaphragmatic hernia usually on?

A

Left

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89
Q

How to detect diaphragmatic hernias

A

USS

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90
Q

PS diaphragmatic hernia

A

Failure t respond to resus/ resp distress

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91
Q

O/E diagragmatic hernia

A

Displaces apex beat + heart sounds to right
Poor entry air into L chest
Bowel sounds in chest?

92
Q

How to diagnose diaphragmatic hernias

A

CXR

93
Q

Mx diaphragmatic hernia

A

NG tube

Surgical repair

94
Q

% survival rate diaphragmatic hernia

A

50%

95
Q

CXR meconium aspiration

A

Irritant to lungs –> obstruction –> chemical pneumonitis

96
Q

Signs meconium aspiration

A

Cord/fingernails green

Resp distress signs

97
Q

Mx meconium asp if baby cries @ birth

A

Normal resp

So no resus

98
Q

Mx meconium asp if baby has reduced breathing

A

CRAP

99
Q

Mx meconium asp if baby not breathing

A

Suction meconium w/ large bore suction catheter

100
Q

Causes of prematurity (5)

A 
Pregnancy induced HTN 
Infection 
PPROM 
Previous pre-term baby 
Anatomical abnormality of cervix or uterus
101
Q

Problems faced by baby born <26w

A 
Resus @ borth 
RDS
Pneumothorax 
APnoea 
Bronchopulmonary dysplasia 
HoTN
PDA
Hypothermia 
Metabolic imbalances 
Jaundice 
Infection 
NEC
ROP
PVLM/IVH
Anemia 
Hernia
102
Q

What is necrotising enterocolitis

A

Bacterial invasion of ischaemic bowel

103
Q

Sx NEC

A

Distended abdo and stool bleed

104
Q

Mortality NEC

A

20%

105
Q

For who is hypoglycaemia likely for in their 1st 24hrs? (6)

A 
IUGR
Pre-term 
Mother w/diabetes 
Large for date
Hypothermic 
Ill
106
Q

Sx hypoglycaemia (5)

A 
Irritability 
Apnoea 
Lethargy 
Drowsiness 
Seizures
107
Q

What level of glucose is required for neurodevelopment

A

> 2.6

108
Q

Tx hypoglycaemia

A

Early + freq feed w/ breast link
If really low - IV infusion glucose
Maybe glucagon + hydrocortisone

109
Q

What can hypothermia cause? (5)

A 
Incr E consumption 
Hypoxia 
Hypoglycaemia 
Failure to gain weight 
Incr mortality
110
Q

Which babies are particularly suscpetible to hypothermia (3)

A

Incr SA:Vol
Thin skin
Decr fat

111
Q

Tx hypothermia

A

Incubate

Humidify air

112
Q

When are episodes of apnoea common in LBW infants?

A

Under 32 weeks

113
Q

When does bradycardia occur with apnoea?

A

If infant doesn’t breath for 20-30s

Breathing against closed glottis

114
Q

Mx apnoea

A

Physical stimulation
Caffeine
CPAP

115
Q

What does retinopathy of prematurity affect?

A

BV at jct of vascular + non-vascular retina

116
Q

What does vascular proliferation in retinopathy lead to?

A

Retinal detachment
Fibrosis
Blindness

117
Q

Tx of retinopathy of prematurity?

A

Laser therapy

Ophthal review every week

118
Q

Who is intraventricular haemorrhage common in?

A

Underweight children/neonates

119
Q

PS intraventricular haemorrhage

A 
Apnoea 
Lethargy 
Poor mm control/tone 
Hydrocephalus 
Incr ICP + bulging fontanelle
120
Q

What can an intraventricular haemorrhage progress into?

A

Coma

121
Q

Mx intraventricular haemorrhage

A

Supportive
Correct acidosis, anaemia + hypotension
Fl - decr ICP
Ventriculoperitoneal shunt

122
Q

If a baby is born at 28w, how long does it taken them to double their weight?

A

6 weeks

123
Q

If a baby is born at term, how long does it take them to double their weight?

A

4/5months

124
Q

At how many weeks is a baby mature enough to swallow milk?

A

35-6

125
Q

NG feeding for less mature babies

A

Cont phosphate protein + Kcal
+ Ca + Vit D
+ Fe
Enterally

126
Q

Advantages of breast milk in premature babies (5)

A 
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
Q

What is bronchopulmonary dysplasia?

A

O2 requirement at post menstrual age @36W

128
Q

Characteristic CHX bronchopulmonary dysplasia?

A

Widespread opacification

129
Q

Mx bronchopulmonary dysplasia

A

Wean onto CPAP

130
Q

Neurodevelomental complications of prematurity

A

Cerebral palsy

Complications of blindness + deafness

131
Q

CV changes after first breath

A 
Decr pulmonary resistance 
x6 incr blood to lungs 
Decr blood to RA (b/c no placenta) 
LA > RA - FO closes 
DA closes
132
Q

How is lung fluid reabsorbed @ birth?

A

Chest compression during birth squeezes out 1/3

Release of adrenaline incr reabsorption

133
Q

Within how long should a baby pass urine?

A

24hrs

134
Q

Within how long should a baby pass meconium?

A

<48hrs

135
Q

How long should it take for a neonate to regain its birth weight?

A

7-10days

136
Q

Normal BW

A

3.5kg

137
Q

Low BW

A

2.5kg

138
Q

V low BW

A

1.5kg

139
Q

Extremely low BW

A

1kg

140
Q

Within how long of delivery should a mother attempt to breastfeed?

A

1hr

141
Q

What prophylaxis must all newborns have?

A

Vitamin K

142
Q

How is vitamin K administered

A

Single IM

or 3x PO dose

143
Q

Why is Vit K given prophylactically?

A

Prevent haemorrhagic disease of newborn

144
Q

When does haemorrhagic disease of the newborn occur?

A

In 1st week of life

or up to 8 weeks

145
Q

If mild, what are the Sx of haemorrhagic disease of the newborn?

A

Bruising
Haematemesis
Melena
Prolonged bleeding from umbilical stump

146
Q

If severe, what are the Sx of haemorrhagic disease of the newborn?

A

Intracranial haemorrhage –> brain damage/death

147
Q

Why is Vit K low in the newborn? (4)

A

Poor placental transfer
Absence of Vit K prod bacteria in neonatal gut
Liver immaturity
Breast milk has low levels of vit K

148
Q

Vit K regime if mother takes anticonvulsants

A

PO prophylaxis from 36w + IM injection

149
Q

When should the new born exam happen?

A

Within 72hrs

150
Q

When is peripheral cyanosis common?

A

1st day

151
Q

Why might a baby have swollen eyes and distortion of head shape

A

From delivery

152
Q

What are epstein pearls

A

White pears on palate

153
Q

When is erythema toxicum common?

A

2-3 days

154
Q

What is erythema toxicum

A

White pinpoint papules in erythematous base

On trunk

155
Q

What is Milia?

A

Baby acne

156
Q

What is caput secundum

A

Oedematous swelling on scalp b/c pressure against cervix

157
Q

Cephaematoma

A

Subperiosteal collection of blood

After rupture of vessels betw skull + periosteum

158
Q

When does port-wine stain occur

A

From birth

159
Q

When does strawberry naevus occur?

A

1st month

160
Q

What is Guthrie?

A

Heel prick test taken @ 5-9 days

161
Q

What does the Guthrie test screen for? (4)

A

PKU
Hypothyroid
Haemoglobinopathies - sickle cell, B thalassaemia
MCAD

162
Q

What 3 things are noted if CF?

A

Serum trypsin

Incr in pancreatic duct obstruction

163
Q

When does a hearing test occur/

A

Within 2 weeks of birth

164
Q

What is EOAE testing

A

Earphone over ear

Sound evokes ech from cochlear if fct normal

165
Q

Appearance of a capillary haemangioma

A

Pink macule on upper eye lid, mid forehard or neck distension of dermal capillaris

166
Q

Reasons for feeding difficulties in the newborn (4)

A

Cleft lip/palate
Premature - unable to suck/swallow
Poor attachment to nipple
GORD

167
Q

What is a brachial plexus injury ?

A

Traction of branchial nn root

168
Q

Who is at increased risk of a brachial plexus injury?

A

Breech

Shoulder dystocia

169
Q

Features of Erbs palsy

A

Arm lies flat, limp
Hand pronated
Fingers flexed

170
Q

Outcome brachial plexus injury

A

Most resolve completely

If not by 2-3months - Rx

171
Q

What is Sticky eye

A

Yellow discharge from corner of eye –> crusting

172
Q

Why does sticky eye occur?

A

Blockage of small tear ducts

173
Q

Mx Sticky Eye

A

Bathe - sterile H2O

174
Q

Why does Haemolytic disease of newborn occur?

A

Transplacental transfer maternal antibodies –> immune haemolysis of RBC in newborn

175
Q

Causes haemolytic disease of newborn (3)

A

Rhesus
ABO
Other antibodies - Kell, Duffy

176
Q

Antenatal presentation of Rhesus

A

Coombes test - presence antiD antibodies mother

USS - hydrops fetalis/polyhydramnios

177
Q

Neonatal presentation Rhesus

A

Jaundice
Oedema
HS megaly

178
Q

Ix Rhesus (4)

A

Coombs
USS
FBS
Post natal - umbilical blood sampling

179
Q

Mx Rhesus

A

O transfusion via umbilical vv if anaemia

180
Q

What % babies w/ Rhesus = norm @ birth

A

50% (still monitor for late anaemia)

181
Q

What % Rhesus babies req transfusion

A

25%

182
Q

How to Tx jaundice assoc w/ Rhesus

A

Phototherapy

183
Q

Mother + father blood groups for ABO incompatibility

A

Type A/B father

Type O mother

184
Q

PS ABO incompatibility

A

Jaundice but not as sever RH

185
Q

When does ABO incompatibility peak?

A

12-72hrs

186
Q

Mx ABO incompatibility

A

Severe - transfusion
Neonatal blood test
Phototherapy

187
Q

Prognosis ABO incompatibility

A

SNHL

188
Q

Main RF for congenital abnormalities (5)

A 
Maternal/paternal age 
Consanguinity 
Infections - TORCH
Toxins - alcohol, smoking, mercury, Dx
Dietary deficiency - folic acid, too much vit A
189
Q

CHARGE

A 
Coloboma of eye 
Heart Defect 
Atresia of nasal choaenae 
Retardation of growth 
Genitourinary 
Ear and deafness
190
Q

VACTERL

A 
Vertebral defects/scoliosis 
Anal Atresia 
CV abnormalities 
TO fistula 
Eosophageal atresia 
Renal abnormalities 
Limb defects
191
Q

What is VACTERAL associated with

A

Diabetic mothers

Edwards (trisomy 18)

192
Q

What is Trisomy 13?

A

Patau

193
Q

Risk factors Patau

A

Female

Incr maternal age

194
Q

PS Patau

A 
LBW 
Congenital heart defects - 
Holoprosencephaly 
NTD
Severe LD 
Small eyes 
Scalp structures 
Gastro/UG defect 
Plydactylyl
195
Q

Congenital heart defects associated with Patau’s (4)

A

ASD, VSD, PDA, dextrocardia

196
Q

Holoprosencephaly

A

Defect in brain hence doesn’t split into 2 halves

197
Q

Median survival neonate with Pataus

A

2.5 days

198
Q

What is Trisomy 18

A

Edwards

199
Q

What % foetuses with Edwards will die?

A

95%

200
Q

Prenatal features Edwards (7)

A 
Polyhydramnios 
Oligohydramnios 
Small placenta 
Single umbilical aa 
Fetal distress 
IUGR 
Weak fetal activity
201
Q

Postnatal features Edwards (8)

A 
LBW 
Craniofacial abnormality 
Skeletal abnormalities - overlapping fingers, prominents calcaneus 
Heart defects 
GI abnormalities 
Urogenital - hydronephrosis 
Neuro - hydrocephaly, LD 
Pulmonary hypoplasia
202
Q

Mean life expectancy Edwards

A

4 days

203
Q

Anencephaly

A

Failure to develop most of cranium/brain

204
Q

Prognosis Anencephaly

A

Still born/die @birth

205
Q

Encephalocele

A

Midline skull defects –> extrusion of brain/meninges

206
Q

Mx encephalocele

A

Surgical correction

207
Q

Spina bifida occulta

A

Failure of fusion of vertebral arch

208
Q

Appearance spina bifida in lumbar region

A

Tuft of hair, lipoma, birthmark or dermal sinus

209
Q

Meningocele

A

Skin + meninges form out-pouching
Cord remains in meninges
PS similar to spina bifida

210
Q

Myelomeningocele

A

Communication between surface + meninges

211
Q

Complications myelomeningocele

A 
Paralysis 
Sensory loss 
Mm imbalance 
Neuropathic bladder 
Scoliosis 
Hydrocephalus
212
Q

Male - ambiguous genitalia

A

Hypospasias + bifid scrotum

Undescended/palpable testes

213
Q

Female - ambiguous genitalia

A

Clitoral hypertrophy

Vulva + single opening

214
Q

Ovotesticular disorder of sex development

A

Both XX + Y cells present in foetus hence both testes + ovarian tissue

215
Q

What is Potters sydrome

A

Pressure in utero –> oligohydramnios –> urgenital abnormalities

216
Q

When do foetal kidneys develop?

A

Betw 5-7w

217
Q

When does foetus urine production start?

A

From 14 weeks

218
Q

Potters syndrome PS (7)

A 
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
Q

What is HIE due to?

A

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
Q

Mild HIE (4)

A

Irritable
Respond to excessive stimulation
Hyperventilation
Impaired feeding

221
Q

Moderate HIE (3)

A

Tone abnormalities
Can’t feed
Seizures

222
Q

Severe HIE (4)

A

No norm/spontaneous movements
Hypertonia/hypotonia fluctuation
Prolonged seizures
Multi-organ failure

223
Q

Mx HIE (7)

A 
Resp support 
EEG
Seizure Tx
Fl restriction 
Tx HoTN 
Monitor hypoglycaemia, electrolyte imbalance 
Cool child to 33/34' within 6hrs
224
Q

Prognosis mild HIE

A

Excellent

225
Q

Prognosis mod HIE

A

If full recovery by 2 weeks = excellent

226
Q

Prognosis severe HIE

A

Mort 30-40%

80% have neurodevelopmental issues

227
Q

What is acrocyanosis and is it normal

A

Peripheral cyanosis around extremities
is completely normal
due to benign vasomotor changes –> peripheral vasoconstriction

CP2 PAEDS (18 decks)

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