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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
Q

What are the features of intra-ventricular haemorrhage?

A

Graded I-IV, worsening severity with increasing grade
Prevention with antenatal steroids
Treatment is mainly symptomatic, can do drainage

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26
Q

What are the features of patent ductus arteriosus?

A 
Additional blood supply to pulmonary circulation causes over-perfusion of lungs and systemic ischaemia 
Consequences:
•	Worsening respiratory syndromes
•	Retention of fluid
•	Gastrointestinal ischaemia
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27
Q

What are the features of necrotising entero-colitis?

A

Ischaemic and inflammatory changes
Necrosis of bowel
Surgery often required
Conservative management sometimes possible- Abx + parenteral nutrition

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28
Q

How is the outcome of extreme prematurity assessed?

A

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

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29
Q

Generally, what is the prognosis for extreme prematurity?

A

1/3 dies
1/3 have normal life or mild disability
1/3 have moderate or severe disability

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30
Q

What are the common skin manifestations of neonatal problems?

A

Jaundice
Plethora- red appearance to skin caused by excess of blood. Causes include polycythaemia
Cyanosis- central or peripheral

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31
Q

What is erythema toxicum?

A

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

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32
Q

What is a mongolian blue spot?

A

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
Q

What is naevus simplex?

A

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
Q

What is naevus flammeus?

A

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
Q

What is a capillary haemangioma?

A

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
Q

What are the risk factors for neonatal hypoglycaemia?

A 
Premature babies
Perinatal stress
Infants of diabetic mothers
Hypothermia
Sepsis
37
Q

What are the symptoms of hypoglycaemia in neonates?

A 
Jitteriness
Temperature instability
Lethargy
Hypotonia
Apnoea, irregular respirations
Poor suck / feeding
Vomiting
High pitched or weak cry
Seizures
Asymptomatic
38
Q

What are the benefits of breast feeding?

A

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
Q

What are the features of tongue ties?

A

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
Q

How is respiratory distress assessed in neonates?

A

Respiratory rate
Increased effort (Grunting, retractions, nasal flaring)
Colour
Oxygen saturations

41
Q

Which areas should be checked for retractions?

A

Substernal
Subcostal
Intercostal
Suprasternal

42
Q

What is the cause of cleft lip?

A

A failure of the maxillary and medial nasal processes to merge

43
Q

What portion of patients with cleft lip also have a cleft palate?

A

70%

44
Q

How is cleft lip classified?

A

Can be incomplete (small gap in lip) or complete (continues into nose).
Can be unilateral (left unilateral more common) or bilateral

45
Q

What management is required in cleft lip?

A

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
Q

When does retinoblastoma tend to present?

A

If bilateral- usually ~8 months

If unilateral- usually ~28 months

47
Q

What are the presenting symptoms of retinoblastoma?

A 
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
Q

How is retinoblastoma treated?

A

Laser therapy
Chemo
Surgical removal of the eye

49
Q

What are the indications for spinal imaging with spinal dimples?

A

Large dimple
Dimple off midline
Dimple is high
Other cutaneous marker ie hairy tuft

50
Q

What is a cephalohaematoma?

A

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
Q

What are the characteristics of trisomy 21?

A 
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
Q

What are the symptoms of sepsis in neonates?

A 
Baby pyrexia or hypothermia
Poor feeding
Lethargy or irritable
Early jaundice
Tachypnoea
Hypo or hyperglycaemia
Floppy
Asymptomatic
53
Q

What are the risk factors for neonatal sepsis?

A

Maternal carriage of group B streptococci
Maternal pyrexia
Prolonged rupture of membranes

54
Q

How is presumed sepsis in neonates managed?

A

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
Q

What are the commonest causes of neonatal sepsis?

A 
Group B streptococci
E.coli
Listeria
Coag-negative staphylococci
Haemophilus influenzae
56
Q

What are the possible complications of group B streptococci sepsis?

A 
Meningitis
Disseminated intravascular coagulation
Pneumonia and respiratory collapse
Hypotension
Shock
57
Q

What are the possible complications of congenital ToRCH infections?

A 
IUGR
Brain calcifications
Neurodevelopmental delay
Visual impairment
Recurrent infections
58
Q

What are the common causes of respiratory distress in neonates?

A

Sepsis
TTN – transient tachypnoea of the newborn
Meconium aspiration

59
Q

What is the cause of transient tachypnoea of the newborn?

A

Delay in the clearance of foetal lung fluids

60
Q

When does transient tachypnoea of the newborn present?

A

Within the first few hours of life

61
Q

What are the symptoms of transient tachypnoea of the newborn?

A

Grunting
Tachypnoea
Oxygen requirement
Normal gases

62
Q

How is transient tachypnoea of the newborn managed?

A 
Support
Antibiotics
Fluids
Oxygen 
Airway support
63
Q

What is meconium aspiration?

A

Meconium (first stool) aspiration occurs when meconium is inhaled into the lungs

64
Q

What are the risk factors for meconium aspiration?

A

Post-dates
Maternal diabetes
Maternal hypertension
Difficult labour

65
Q

What are the symptoms of meconium aspiration?

A 
Cyanosis
Increased respiratory effort
Grunting
Apnoea
Floppiness
66
Q

How is meconium aspiration investigated and managed?

A

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
Q

How is investigation of the blue baby done?

A 
History and examination
Sepsis screen
Blood gas and glucose
Chest x-ray
Pulse oximetry
ECG
Echo
68
Q

What are the differential diagnoses for the blue baby?

A 
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
Q

How is hypothermia managed in neonates?

A

Admission to NNU and place in incubator if cannot keep temperature stable
Sepsis screen and antibiotics
Check thyroid function
Monitor blood glucose

70
Q

What is birth asphyxia?

A

Birth asphyxia refers to a lack of oxygen at or around birth, leading to multiorgan dysfunction

71
Q

What are the causes of birth asphyxia?

A 
Placental problem
Long, difficult delivery
Umbilical cord prolapse
Infection
Neonatal airway problem
Neonatal anaemia
72
Q

What are the stages of birth asphyxia?

A

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
Q

How is hypoxic ischaemic encephalopathy managed?

A 
Treatment of seizures
Therapeutic hypothermia
Fluid restriction
Monitoring for renal and liver failure
Respiratory and cardiac support
74
Q

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

A 
Constipation
Large bowel atresia
Imperforate anus +/- fistula
Hirschsprungs disease
Meconium ileus (think CF)
75
Q

What is the incidence of neonatal diaphragmatic hernias?

A

Diaphragmatic hernias affect 1 in 2500 live births. 90% are on the left and boys are more commonly affected than girls

76
Q

What is a common association with diaphragmatic hernia?

A

Lung hypoplasia

77
Q

What is neonatal abstinence syndrome?

A

Neonatal abstinence syndrome involves withdrawal from physically addictive substances taken by the mother in pregnancy. These are commonly opioids, benzodiazepines, cocaine and amphetamines

78
Q

How is neonatal abstinence syndrome monitored/diagnosed?

A

Finnegan scores

Urine toxicology

79
Q

How is neonatal abstinence syndrome treated?

A

Comfort (e.g. swaddling)
Morphine
Phenobarbitone

Paediatrics (22 decks)

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