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Paediatrics > Neonatology > Flashcards

Neonatology Flashcards

1
Q

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

A

BP 70/44
Respiratory rate 30-60
Heart rate 120-160

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2
Q

How do newborns theromoregulate?

A

In utero, babies receive their thermoregulation from their mother but when they are born they do not have the ability to shiver for thermoregulation and so they require a metabolic production of heat. This is fulfilled by the brown fat, which is well innervated by sympathetic neurons. Cold stress leads to lipolysis- resulting in heat production

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3
Q

How can newborn breathing be assessed non-invasively?

A

Blood gases

Trans-cutaneous pCO2 and pO2 measurement

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4
Q

How can newborn breathing be assessed invasively?

A

Capnography
Tidal volume
Minute ventilation
Flow-volume loop

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5
Q

When does physiological jaundice start and end?

A

Starts on day of life (DOL) 2-3 and persists until DOL 7-10 in term infants and DOL 21 in premature infants

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6
Q

What is the incidence of physiological jaundice?

A

60% of term babies

80% of preterm babies

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7
Q

When does breastfed jaundice occur and what is the incidence?

A

DOL 30

10%

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8
Q

How much weight loss is normal in neonates and why?

A

Weight loss up to 10% is normal in neonates and occurs due to a shift of interstitial fluid to intravascular and diuresis

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9
Q

For what reasons do premature babies struggle to maintain fluid and electrolyte balance?

A

Less fat in body composition
Increased loss through kidney
Increased insensible water loss via immature skin and breathing

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10
Q

What are the possible causes of prematurity associated anemia?

A

Blood letting
Reduced erythropoesis
Infection

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11
Q

How is intra-uterine growth restriction defined?

A

IUGR= baby born <10th centile in weight

Severe IUGR= baby born <0.4th centile.

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12
Q

What are the common causes of IUGR?

A 
Maternal:
-Smoking
-Pre-eclampsia
Fetal:
-Chromosomal abnormality
-Infection (ie CMV)
Placental:
-Abruption
Other:
-Multiple pregnancy (twin-twin transfusion)
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13
Q

What problems are commonly associated with babies who are small for dates?

A 
Perinatal hypoxia
Hypoglycaemia
Hypothermia
Polycythaemia
Thrombocytopenia
Hypoglycaemia
GI problems
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14
Q

What are the long term complications for babies born small for dates?

A

Hypertension
Reduced growth
Obesity
Ischaemic heart disease

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15
Q

When is a baby considered pre-term?

A

When born <37 weeks

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16
Q

When is a baby considered extremely pre-term?

A

When born <28 weeks

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17
Q

What is considered a low birth weight?

A

<2500g

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18
Q

What is considered a very low birth weight?

A

<1500g

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19
Q

What is considered a extremely low birth weight?

A

<1000g

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20
Q

What is the incidence of prematurity and extreme prematurity?

A

Prematurity- ~5-12% of births in scotland

Extreme prematurity- <0.5% of births

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21
Q

What are the common problems preterm babies experience?

A 
Respiratory distress syndrome
Broncho-pulmonary dysplasia
Intra-ventricular haemorrhage
Peri-ventricular leukomalacia
Post-haemorrhagic hydrocephalus
Persistent ductus arteriosus
Necrotising entero-colitis
Nutritional problems
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22
Q

What are the features of respiratory distress syndrome?

A

Prevention- antenatal steroids
Early treatment- surfactant
Early extubation
Non-invasive support (N-CPAP)

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23
Q

What are the features of broncho-pulmonary dysplasia?

A 
Overstretch due to trauma
Atelectasis
Infection
O2 toxicity
Inflammatory changes
Tissue repair- scarring
Treated with nutrition and steroids
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24
Q

What are the minor respiratory problems associated with prematurity and how are they treated?

A

Apnoea, irregular breathing, desaturations

Treated with caffeine or N-CPAP

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25
What are the features of intra-ventricular haemorrhage?
Graded I-IV, worsening severity with increasing grade Prevention with antenatal steroids Treatment is mainly symptomatic, can do drainage
26
What are the features of patent ductus arteriosus?
``` Additional blood supply to pulmonary circulation causes over-perfusion of lungs and systemic ischaemia Consequences: • Worsening respiratory syndromes • Retention of fluid • Gastrointestinal ischaemia ```
27
What are the features of necrotising entero-colitis?
Ischaemic and inflammatory changes Necrosis of bowel Surgery often required Conservative management sometimes possible- Abx + parenteral nutrition
28
How is the outcome of extreme prematurity assessed?
The outcome of extreme prematurity is unpredictable at birth but a brain ultrasound at the end of the first week can show obvious deformity. There can be some surprising decline or improvement in years 2-6
29
Generally, what is the prognosis for extreme prematurity?
1/3 dies 1/3 have normal life or mild disability 1/3 have moderate or severe disability
30
What are the common skin manifestations of neonatal problems?
Jaundice Plethora- red appearance to skin caused by excess of blood. Causes include polycythaemia Cyanosis- central or peripheral
31
What is erythema toxicum?
Maculo-papular rash, occurs in 30-70% of term babies but is very uncommon in preterm babies. The cause is unknown and the rash recedes on its own by the end of the first week
32
What is a mongolian blue spot?
Blue-grey pigmentations, common on the lower back and buttocks. They occur due to and accumulation of melanocytes and are very common in races with pigmented skin but are less obvious as the skin darkens
33
What is naevus simplex?
Stork marks- light colour capillary dilatation most common at the back of the neck or along the midline of the face. It gradually fades within the first two years
34
What is naevus flammeus?
Port wine stain- present at birth, is flat or slightly raised and will not regress with age. They are caused by dilated, mature capillaries in the superificial dermis. They are associated with Sturge Weber syndrome and Klippel-trenaunay syndrome
35
What is a capillary haemangioma?
Strawberry naevus- cluster of dilated capillaries appearing within the month after birth. They are raised and bright red with discrete edges, occurring in any part of the body. They usually regress by 1 year
36
What are the risk factors for neonatal hypoglycaemia?
``` Premature babies Perinatal stress Infants of diabetic mothers Hypothermia Sepsis ```
37
What are the symptoms of hypoglycaemia in neonates?
``` Jitteriness Temperature instability Lethargy Hypotonia Apnoea, irregular respirations Poor suck / feeding Vomiting High pitched or weak cry Seizures Asymptomatic ```
38
What are the benefits of breast feeding?
Reduces risk of allergic and inflammatory disorders Protects against infection Reduces risk of SIDS Promotes mother and baby bonding Reduces babies risk of obesity, cardiovascular disease and leukaemia
39
What are the features of tongue ties?
Short +/- thickened frenulum Attached anteriorly to the base of the tongue In most cases no treatment is necessary If there is restriction of tongue protrusion beyond the alveolar margins AND feeding is affected then a frenotomy can be done
40
How is respiratory distress assessed in neonates?
Respiratory rate Increased effort (Grunting, retractions, nasal flaring) Colour Oxygen saturations
41
Which areas should be checked for retractions?
Substernal Subcostal Intercostal Suprasternal
42
What is the cause of cleft lip?
A failure of the maxillary and medial nasal processes to merge
43
What portion of patients with cleft lip also have a cleft palate?
70%
44
How is cleft lip classified?
Can be incomplete (small gap in lip) or complete (continues into nose). Can be unilateral (left unilateral more common) or bilateral
45
What management is required in cleft lip?
Feeding and airway problems are common in cleft lip/palate. Due to associated anomalies, the following are important to do in cleft lip/palate: •Hearing screen •Cardiac echo •Remember trisomies
46
When does retinoblastoma tend to present?
If bilateral- usually ~8 months | If unilateral- usually ~28 months
47
What are the presenting symptoms of retinoblastoma?
``` Leukocoria (white pupillary reflex) Strabismus (crossed eye) Red eye Reduced vision 5% will have deletion of chromosome 13q14 and will present with dysmorphic features and failure to thrive ```
48
How is retinoblastoma treated?
Laser therapy Chemo Surgical removal of the eye
49
What are the indications for spinal imaging with spinal dimples?
Large dimple Dimple off midline Dimple is high Other cutaneous marker ie hairy tuft
50
What is a cephalohaematoma?
A soft, non-translucent localised swelling over one or both sides of the head, becoming maximal in size by day 3-4 of life Associated with a haemorrhage beneath the pericranium and will resolve in 3-4 weeks with no required treatment
51
What are the characteristics of trisomy 21?
``` Dysmorphism- low set ears, downward slanting palpebral fissures, epicanthic folds, single palmar creases, wide sandal gap Hypotonia Cardiac defects Learning difficulty Haematological problems Hypothyroidism Early onset Alzheimer’s disease ```
52
What are the symptoms of sepsis in neonates?
``` Baby pyrexia or hypothermia Poor feeding Lethargy or irritable Early jaundice Tachypnoea Hypo or hyperglycaemia Floppy Asymptomatic ```
53
What are the risk factors for neonatal sepsis?
Maternal carriage of group B streptococci Maternal pyrexia Prolonged rupture of membranes
54
How is presumed sepsis in neonates managed?
Admit NNU Partial septic screen (FBC, CRP, blood cultures) and blood gas Consider CXR, LP IV penicillin and gentamicin 1st line 2nd line iv vancomycin and gentamicin Add metronidazole if surgical/abdominal concerns Fluid management and treat acidosis Monitor vital signs and support respiratory and cardiovascular systems as required
55
What are the commonest causes of neonatal sepsis?
``` Group B streptococci E.coli Listeria Coag-negative staphylococci Haemophilus influenzae ```
56
What are the possible complications of group B streptococci sepsis?
``` Meningitis Disseminated intravascular coagulation Pneumonia and respiratory collapse Hypotension Shock ```
57
What are the possible complications of congenital ToRCH infections?
``` IUGR Brain calcifications Neurodevelopmental delay Visual impairment Recurrent infections ```
58
What are the common causes of respiratory distress in neonates?
Sepsis TTN – transient tachypnoea of the newborn Meconium aspiration
59
What is the cause of transient tachypnoea of the newborn?
Delay in the clearance of foetal lung fluids
60
When does transient tachypnoea of the newborn present?
Within the first few hours of life
61
What are the symptoms of transient tachypnoea of the newborn?
Grunting Tachypnoea Oxygen requirement Normal gases
62
How is transient tachypnoea of the newborn managed?
``` Support Antibiotics Fluids Oxygen Airway support ```
63
What is meconium aspiration?
Meconium (first stool) aspiration occurs when meconium is inhaled into the lungs
64
What are the risk factors for meconium aspiration?
Post-dates Maternal diabetes Maternal hypertension Difficult labour
65
What are the symptoms of meconium aspiration?
``` Cyanosis Increased respiratory effort Grunting Apnoea Floppiness ```
66
How is meconium aspiration investigated and managed?
Investigations can include blood gases, septic screen and a chest x-ray. Treatment involves: •Suction below cords •Airway support •Fluids and IV Abx •Surfactant •NO or ECMO (extracorporeal membrane oxygenation)
67
How is investigation of the blue baby done?
``` History and examination Sepsis screen Blood gas and glucose Chest x-ray Pulse oximetry ECG Echo ```
68
What are the differential diagnoses for the blue baby?
``` Transposition of the great arteries Tetralogy of Fallot Total anomalous pulmonary venous drainage (TAPVD) Hypoplastic left heart syndrome Tricuspid atresia Truncus arteriosus Pulmonary atresia ```
69
How is hypothermia managed in neonates?
Admission to NNU and place in incubator if cannot keep temperature stable Sepsis screen and antibiotics Check thyroid function Monitor blood glucose
70
What is birth asphyxia?
Birth asphyxia refers to a lack of oxygen at or around birth, leading to multiorgan dysfunction
71
What are the causes of birth asphyxia?
``` Placental problem Long, difficult delivery Umbilical cord prolapse Infection Neonatal airway problem Neonatal anaemia ```
72
What are the stages of birth asphyxia?
First stage- within minutes without oxygen, cell damage occurs due to lack of oxygen Second stage- reperfusion injury, involves toxins being released from cells and can last days or weeks
73
How is hypoxic ischaemic encephalopathy managed?
``` Treatment of seizures Therapeutic hypothermia Fluid restriction Monitoring for renal and liver failure Respiratory and cardiac support ```
74
What are the causes of failure to pass stool in neonates?
``` Constipation Large bowel atresia Imperforate anus +/- fistula Hirschsprungs disease Meconium ileus (think CF) ```
75
What is the incidence of neonatal diaphragmatic hernias?
Diaphragmatic hernias affect 1 in 2500 live births. 90% are on the left and boys are more commonly affected than girls
76
What is a common association with diaphragmatic hernia?
Lung hypoplasia
77
What is neonatal abstinence syndrome?
Neonatal abstinence syndrome involves withdrawal from physically addictive substances taken by the mother in pregnancy. These are commonly opioids, benzodiazepines, cocaine and amphetamines
78
How is neonatal abstinence syndrome monitored/diagnosed?
Finnegan scores | Urine toxicology
79
How is neonatal abstinence syndrome treated?
Comfort (e.g. swaddling) Morphine Phenobarbitone

Paediatrics (22 decks)

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