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Paeds > Neonatology > Flashcards

Neonatology Flashcards

1
Q

How long does the neonatal period last?

A

28d

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2
Q

What are milia and how should they be treated?

A

1-2mm pearly, white papules caused by retention of keratin in dermis
Will resolve spontaneously

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3
Q

Describe erythema toxicum:

A

Harmless red blotches often with central white pustule

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4
Q

What is cradle cap?

A

Large, greasy yellow or brown scales on scalp

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5
Q

Describe a port-wine stain:

A

Vascular malformation of superficial dermal capillaries

Pink to deep red/purple patches, often unilateral with distinct cut off

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6
Q

Describe (Mongolian) blue spots:

A

Blue lesion present at births, usually on buttocks or base of spine

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7
Q

What causes petechial and subconjunctival haemorrhages in neonate?

A

Suffusion of face during delivery

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8
Q

What are some important causes of sticky eye in the neonate to rule out?

A

Ophthalmia neonatorum or chlamydia

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9
Q

How can laryngomalacia present?

A

Stridor, feeding difficulties, choking, poor weight gain

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10
Q

How can neonatal jaundice be primarily investigated?

A

Transcutaneous bilirubin levels can be measured by midwives

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11
Q

What are some physiological causes of jaundice in the neonate?

A

Increased bilirubin production due to shorter RBC lifespan
Decreased bilirubin conjugation due to hepatic immaturity
Absence of gut flora impeded elimination of bile pigment
Exclusive breastfeeding

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12
Q

What are some causes of jaundice within 24h of birth?

A

Sepsis
Rhesus haemolytic disease
ABO incompatibility
Red cell anomalies (spherocytosis, G6PDH def.)

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13
Q

What are some causes of prolonged jaundice in neonates?

A

Breastfeeding
Sepsis
Hypothyroidism
CF
Biliary atresia (yellow urine, pale stools)
Galactosemia, congenital infections, haemolysis

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14
Q

How should bilirubin levels be used to decide management in neonatal jaundice?

A

Plot SBR on personalised NICE graph to decide if treatment is required

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15
Q

What are the management options for neonatal jaundice requiring treatment?

A

Phototherapy and exchange transfusion

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16
Q

How does phototherapy work in treating neonatal jaundice?

A

Uses light energy to convert bilirubin to soluble products that can be excreted

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17
Q

What are some side effects of phototherapy for neonatal jaundice?

A

Eye damage, diarrhoea, fluid loss, separation from mother

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18
Q

How does exchange transfusion work in treating neonatal jaundice?

A

Uses warmed blood, 160ml/kg, to remove bilirubin

Given ideally via umbilical vein IVI

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19
Q

What is kernicterus?

A

Acute bilirubin encephalopathy with lethargy, poor feeding, hypertonicity, shrill cry

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20
Q

What are some long term consequences of kernicterus?

A

Athetoid movements, deafness and lower IQ

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21
Q

When can a leak of fetal red cells into the maternal circulation occur?

A 
Threatened miscarriage
APH
Trauma
Amniocentesis + CVS
ECV
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22
Q

What is the cause of respiratory distress syndrome in a newborn?

A

Deficiency in alveolar surfactant leads to atelectasis and re-inflation with each breath exhausts baby leading to resp failure

23
Q

What are some signs of respiratory distress syndrome?

A 
Increased work of breathing within 4h of birth
Tachypnoea
Grunting
Nasal flaring, intercostal recession
Cyanosis
24
Q

How can respiratory distress syndrome be prevented?

A

Betamethasone/dexamethasone offered to those at risk of pre-term delivery from 23-35 weeks

25
Q

What O2 sats should be aimed for when treating respiratory distress syndrome and why?

A

85-93% to reduce risk of retinopathy and bronchopulmonary dysplasia

26
Q

What is the causes of bronchopulmonary dysplasia?

A

Barotrauma, oxygen toxicity and airway infections, as a result of prolonged ventilation + O2

27
Q

What can cause pulmonary hypoplasia?

A

Oligohydramnios, PROM, diaphragmatic hernia

28
Q

What are some signs of necrotising enterocolitis?

A 
Abdo distension
Blood/mucus PR
Tenderness
Shock, DIC
Mucosal sloughing
Pneumatosis intestinalis
29
Q

What is the cause of haemorrhagic disease of the newborn?

A

No enteric bacteria to make vit K so get bleeding/bruising, raised PT and PTT

30
Q

What is the cause of transient tachypnoea of the newborn? When is it more commonly seen?

A

Delayed resorption of fluid in the lungs

More common following C-sections

31
Q

What is the first step in neonatal life support?

A

Dry and stimulate baby and place under radiant heat

32
Q

What scoring system is used in neonatal life support?

A

AGPAR

33
Q

What is the definition for chronic lung disease in newborns?

A

Requiring oxygen for >28 days

34
Q

What are some signs of intraventricular haemorrhage and why is it more common in premature babibes?

A

Seizures, bulging fontanelles, cerebral irritability

BVs unsupported

35
Q

Describe retinopathy of prematurity:

A

Disorganized growth of retinal blood vessels which may result in scarring and retinal detachment
Can be due to O2 toxicity or hypoxia

36
Q

What is the treatment for retinopathy of preamturity?

A

Diode laser therapy

37
Q

When should newborns be screened for retinopathy of prematurity?

A

Screen at 30-31 weeks if ≤27 weeks or at 28-35 days of life

38
Q

What are the likely causative organisms of early onset (within 48h) neonatal sepsis?

A

GBS, E. coli, Listeria

39
Q

What are the likely causative organisms of late onset neonatal sepsis?

A

Coagulase negative staph, S. aureus, E. coli, GBS

40
Q

Describe some ways in which neonatal sepsis may present:

A

Labile temperature, lethargy, poor feeding, resp distress, collapse, DIC

41
Q

What are some risk factors for early onset neonatal sepsis?

A

ROM >18h, maternal infection, mother GBS carrier,

preterm labour, fetal distress, breaks in neonatal skin

42
Q

What are some risk factors for late onset neonatal sepsis?

A

Central lines, catheters, congenital malformations,

severe illness, malnutrition, immunodeficiency

43
Q

What antibiotics should be given in early onset neonatal sepsis?

A

Broad spec e.g. benpen + gent

44
Q

What antibiotics should be given in late onset neonatal sepsis?

A

Broad spec e.g. flucloxacillin + gent

45
Q

What are some cause of hypotonia in the newborn?

A 
Sepsis
Hypoglycaemia
Dehydration, poor nutrition 
Hypoxic-ischemic encephalopathy 
Myopathy
Maternal drugs
46
Q

What are some advantages to breastfeeding?

A 
Less insulin resistance, HTN and obesity
Protect from infection
Promote growth of enteric bacteria
Contraceptive
Protection from breast cancer
Bonding
47
Q

What are some problems associated with breastfeeding?

A

Breast engorgement, breast abscess, sore nipples, mastitis

48
Q

Describe standard infant formula milk:

A

Cow’s milk humanised by reducing solute load and

modifying fat, protein and vitamin content

49
Q

Describe follow on formula milk:

A

Protein is casein based rather than whey (used in standard), delaying stomach emptying and allowing less frequent feeds

50
Q

Why is hydrolized formula milk used?

A

Cows’ milk allergy

51
Q

How much milk do babies need a day?

A

150ml/kg/day

Usually over 4-6 feeds

52
Q

Describe weaning and when it should occur:

A

Introduce solids at 6 months by offering finger food with or without purée

53
Q

What does APGAR stand for?

A 
Activity
Pulse
Grimace
Appearance
Respiration
54
Q

What is a normal APGAR score?

A

7+

Paeds (2 decks)

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