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Paediatrics > Neonatology > Flashcards

Neonatology Flashcards

1
Q

What is the pathology of hypoxic ischaemic encephalopathy?

A

Neonatal brain injury secondary to pre-natal, peri-natal or post-natal asphyxia

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2
Q

What are the signs of hypoxic-ischaemic encephalopathy (asphyxia)?

A

Mild - irritable, increased tone, staring eyes, poor feeding
Mod - lethargy, reduced tone, seizures
Severe - coma, proglonged seizures, multi-organ failure

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3
Q

What investigations would be done if hypoxic-ischaemic encephalopathy was suspected?

A 
Abnormal cardiotocograph (CTG)
Poor apgar score
Metabolic acidosis
EEG
MRI
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4
Q

How is hypoxic-ischaemic encephalopathy treated?

A

Fluid resuscitation
Respiratory and circulatory support
Anticonvulsants
Cooling

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5
Q

What are the complications of hypoxic-ischaemic encephalopathy?

A

Cerebral palsy
Learning difficulties
Epilepsy
Hearing and visual impairment

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6
Q

Apgar score

A 
Appearance
Pulse rate
Grimace
Activity
Respiration
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7
Q

What is the pathology of respiratory distress syndrome?

A

Lack of surfactant

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8
Q

What are the causes of respiratory distress syndrome?

A 
Pre-mature
Meconium aspiration
Congenital pneumonia
Heart failure
Pneumothorax
Diaphragmatic hernia
Transient tachypnoea of the newborn
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9
Q

What are the signs of respiratory distress syndrome?

A 
Tachypnoea - RR 60/min
Grunting
Intercostal/subcostal recession
Cyanosis
Hypercapnia
Respiratory distress
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10
Q

What investigations would be done if respiratory distress syndrome was suspected?

A

CXR

ECHO if cardiac cause

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11
Q

How is respiratory distress syndrome treated?

A

Endotracheal surfactant
Intubation and ventilation
Continuous positive airway pressure (CPAP)

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12
Q

What are the complications of respiratory distress syndrome?

A

Short-term - pneumothorax, infection, apnoea

Long-term - chronic lung disease of prematurity

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13
Q

How can respiratory distress syndrome be prevented?

A

Antenatal dexamethasone

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14
Q

What is the pathology of necrotising entero-colitis?

A

Ischaemic and inflammatory changes

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15
Q

What are the signs of necrotising entero-colitis?

A 
Abdominal distention
Shiny abdomen
Colour changes
Green bile
Absent bowel sounds
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16
Q

How is necrotising entero-colitis investigated?

A

X-ray

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17
Q

How is necrotising entero-colitis treated?

A

Nil by mouth
Antibiotics
Parental nutrition
Surgery

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18
Q

What are the complications of necrotising entero-colitis?

A

Peritonitis
Sepsis
Death
Abscess formation

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19
Q

What are the causes of neonatal sepsis?

A 
Prolonged rupture of membranes (>24hrs)
Chorioamnionitis
Maternal pyrexia/sepsis
Maternal carriage of group B strep
Prematurity
20
Q

What pathogens are responsible for neonatal sepsis?

A 
GBS - group B strep
E.coli
Chlamydia
Gonorrhoea
Listeria
HSV
21
Q

What are the signs of neonatal sepsis?

A

Respiratory distress
Apnoea
Temperature instability
Poor feeding

22
Q

What investigations would be done if neonatal sepsis was suspected?

A 
Bloods - CRP, WBC
Blood culture
Lumbar puncture
Urine MC&S
CXR
23
Q

How is neonatal sepsis treated?

A

Maternal antibiotics when risk factors for sepsis are present
Strict infection control

24
Q

What are causes of hypoglycaemia?

A 
Prematurity
Small for gestational age
Macrosomia
Infants of diabetic mothers
Sepsis
Polycythaemia
Metabolic
25
Q

What are signs of neonatal hypoglycaemia?

A 
Jitteriness
Poor feeding
Drowsiness
Apnoea
Seizures
26
Q

How is hypoglycaemia investigated in the newborn?

A

BG <2.5mmol/L

Metabolic screen if persistent or severe hypoglycaemia

27
Q

How is hypoglycaemia treated?

A

Early and frequent milk feeds

IV 10% dextrose

28
Q

What are the complications of neonatal hypoglycaemia?

A

Seizures

Neurological disability

29
Q

What is transient tachypnoea of the newborn?

A

Self-limiting, presents within 1st few hours of life

30
Q

What are the signs of transient tachypnoea of the newborn?

A

Grunting
Tachypnoea
Oxygen requirement

31
Q

How is transient tachypnoea of the newborn treated?

A 
Supportive
Antibiotics
Fluids
O2
Airway support
32
Q

What are the risk factors for meconium aspiration?

A

Post-term
Maternal diabetes
Maternal hypertension
Difficult labour

33
Q

What are the signs of meconium aspiration?

A 
Cyanosis
Increased work of breathing
Grunting
Apnoea
Floppiness
34
Q

What investigations would be done if meconium aspiration was suspected?

A

Blood gas
Septic screen
CXR

35
Q

How is a meconium aspiration managed?

A 
Suction below cord
Airway support
Fluids
IV antibiotics
Surfactant
36
Q

What are common complications of prematurity?

A 
Respiratory distress syndrome
Patent ductus arteriosus
Necrotising enterocolitis
Retinopathy of prematurity
Intraventricular haemorrhage
Hypothermia
Hypoglycaemia
Poor feeding
Neonatal jaundice
37
Q

What are common post-natal problems?

A 
Jaundice
Plethora
Cyanosis
Erythema toxicum
Mongolian blue spots
Naevus simples
Naeverus flammeus
Strawberry naevus
Hypoglycaemia
Cleft lip/palate
Cataracts
Retinoblastoma
38
Q

Plethora

A

Redness

May be due to polycythaemia

39
Q

Erythema toxicum

A

Maculo-papular rash
Cause unknown
Clears by the end of 1st 2nd week

40
Q

Mongolian blue spots

A

Blue-grey pigmentations

Acculumation of melanocytes

41
Q

Naevus simples

A

Light colour capillary dilatation
Gradually fades within 1st/2nd years
(Grey) - looks like stork lines

42
Q

Narverus flammeus

A

Presents at birth

Caused by dilated mature capillaries in the superficial dermis

43
Q

Strawberry naevus

A

(capillary haemangioma)
Cluster of capillaries which appear within the first month after birth
Raised and bright red

44
Q

What is gastrochisis?

A

Abdominal wall defect - gut eviscerated and exposed, NOT COVERED
Management - primary/delayed closure, TPN
Survival - 90%, short gut

45
Q

What is exomphalos?

A

Umbilical defect with covered viscera - typically encloses the bowel and liver
Management - primary/delayed closure
Post-natal mortality 25%

46
Q

What are common congenital infections?

A 
TORCH:
Toxoplasmosis
Other - HBV, syphilis, varicella zoster, HIV, parvovirus B19 (slapped cheek)
Rubella
CMV (cytomegalovirus)
HSV
Give aciclovir

Paediatrics (17 decks)

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