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Child Health > Neonatology > Flashcards

Neonatology Flashcards

1
Q

All preterm babies should be heated while being stabilised before transfer to the NICU. How should a baby aged > 28 weeks be heated?

A

Dried and wrapped in a warm towel

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2
Q

All preterm babies should be heated while being stabilised before transfer to the NICU. How should a baby aged < 28 weeks be heated?

A

Don’t dry, and place trunk and limbs in a plastic bag loosely tied around the neck

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3
Q

What respiratory support is required for a preterm baby with a good heart rate and respiratory effort before being transferred to the NICU?

A

Facial O2 or CPAP

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4
Q

What respiratory support is required for a preterm baby with poor respiratory effort or signs of respiratory distress before being transferred to the NICU? What medication should also be administered to these babies?

A

Intubation for mechanical ventilation, also give surfactant

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5
Q

Describe what is meant by a low, very low and extremely low birthweight baby?

A

Low = < 2500g, very low = < 1500g, extremely low = < 1000g

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6
Q

What gestational age would be classified as a late preterm baby?

A

34-37 weeks

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7
Q

What gestational age would be classified as a moderately preterm baby?

A

32-34 weeks

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8
Q

What gestational age would be classified as a very preterm baby?

A

28-32 weeks

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9
Q

What gestational age would be classified as an extremely preterm baby?

A

< 28 weeks

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10
Q

Name 3 reasons why premature babies are at increased risk of hypothermia?

A

Thin skin, large surface area, low subcutaneous fat stores

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11
Q

How can hypothermia be prevented in a preterm neonate?

A

Use of an incubator and a hat to prevent heat loss

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12
Q

Preterm babies have a very fragile gut, which makes them more susceptible to which serious condition affecting the bowel?

A

Necrotising enterocolitis

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13
Q

At what age (in weeks) does the suck and swallow reflex develop?

A

34 weeks

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14
Q

How are preterm babies aged < 34 weeks usually fed?

A

IV nutrition while gradually introducing milk via an NG tube

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15
Q

Many preterm neonates require multiple courses of antibiotics. This can therefore increase the risk of which other type of infection?

A

Fungal

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16
Q

Babies who were born preterm receive follow-up for how long to monitor their growth and development?

A

For the first year of life

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17
Q

What is the cause of neonatal respiratory distress syndrome?

A

Lack of surfactant

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18
Q

What happens to lung compliance in neonatal respiratory distress syndrome?

A

Decreased

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19
Q

If a preterm neonate presents with respiratory distress at delivery or within 4 hours of birth, what diagnosis should you suspect?

A

Respiratory distress syndrome

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20
Q

What are the 4 main signs of respiratory distress that may be seen in a neonate?

A

Tachypnoea, grunting, cyanosis and recession

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21
Q

Neonatal respiratory distress syndrome is mainly a clinical diagnosis which can be confirmed with which investigation? What will this show?

A

CXR - will show a ‘ground-glass appearance’

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22
Q

How can neonatal respiratory distress syndrome be prevented pre-delivery?

A

By giving maternal steroids when there is a risk of preterm delivery

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23
Q

What medication is used to manage neonatal respiratory distress syndrome?

A

Surfactant

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24
Q

What ventilatory management is required for neonates with severe symptoms of respiratory distress syndrome?

A

Oxygen via mechanical ventilation

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25
Q

What ventilatory management is required for neonates with mild symptoms of respiratory distress syndrome?

A

Oxygen via nasal cannula or CPAP

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26
Q

What are the three main complications of mechanical ventilation in a neonate?

A

Pneumothorax, pulmonary haemorrhage and chronic lung disease

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27
Q

Chronic lung disease (bronchopulmonary dysplasia) is caused by lung tissue inflammation secondary to what things?

A

RDS, mechanical ventilation and oxygen toxicity

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28
Q

Chronic lung disease (bronchopulmonary dysplasia) can be diagnosed when there is a need for supplemental oxygen to maintain saturations > 95% after what gestational age?

A

36 weeks

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29
Q

If not prevented, how is chronic lung disease (bronchopulmonary dysplasia) managed?

A

Supplemental oxygen (usually via a nasal cannula)

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30
Q

Babies who develop chronic lung disease (bronchopulmonary dysplasia) are at increased risk of developing what other respiratory condition in the first year of life?

A

Bronchiolitis

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31
Q

All premature babies of what gestation will have apnoea?

A

< 28 weeks

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32
Q

What is the most common cause of apnoea of prematurity?

A

Immature respiratory drive

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33
Q

What management is required for preterm babies who have apnoeic episodes occurring frequently in succession?

A

Mechanical ventilation

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34
Q

What medication is given to all preterm babies daily in order to stimulate their respiratory centre to initiate breaths?

A

Caffeine

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35
Q

Periventricular leukomalacia is a complication of prematurity which follows what event?

A

Ischaemic brain injury

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36
Q

Preterm babies are at increased risk of developing intraventricular haemorrhage. This is a bleed into the ventricles which originates from where?

A

Germinal matrix

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37
Q

Both periventricular leukomalacia and intraventricular haemorrhage are usually asymptomatic. How would these usually be detected?

A

Cranial ultrasound

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38
Q

A sudden deterioration in the clinical state of a neonate with prolonged apnoea, bradycardia or a rapid drop in haemoglobin should make you consider what diagnosis?

A

Intraventricular haemorrhage

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39
Q

How should intraventricular haemorrhage in a neonate be managed?

A

Weekly cranial ultrasound scans throughout the hospital stay

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40
Q

What is the most significant complication of an intraventricular haemorrhage in a neonate?

A

Hydrocephalus

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41
Q

If intraventricular haemorrhage is severe and associated with complications such as hydrocephalus, what are some long-term adverse outcomes that can occur?

A

Cerebral palsy, visual impairment, intellectual disability

42
Q

When does necrotising enterocolitis typically present?

A

The 2nd or 3rd week of life

43
Q

What is the classic triad of symptoms which would be seen in a neonate with necrotising enterocolitis?

A

Bilious vomit, abdominal distension and bloody stools

44
Q

Necrotising enterocolitis is predominantly a clinical diagnosis; however, what investigation may be useful as a supportive test?

A

AXR

45
Q

An AXR showing gas in the bowel, known as ‘pneumatosis intestinalis’ is pathognomonic of which condition?

A

Necrotising enterocolitis

46
Q

If an AXR of a neonate with necrotising enterocolitis shows free air in the abdomen- what complication has occurred?

A

Bowel perforation

47
Q

How can necrotising enterocolitis be prevented?

A

By introducing feeds gradually, preferably with breast milk

48
Q

How is necrotising enterocolitis managed?

A

Intensive care support, stop feeding, analgesia and antibiotics

49
Q

If a neonate has a large length of bowel removed as a complication of necrotising enterocolitis, this can cause what complication?

A

Short gut syndrome

50
Q

What are the two main conditions which are more commonly seen in term babies, compared to preterm babies?

A

Meconium aspiration syndrome and hypoxic ischaemic encephalopathy

51
Q

How soon after delivery should meconium be passed?

A

Within 48 hours

52
Q

A history of meconium stained amniotic fluid and respiratory distress at delivery is suggestive of what diagnosis?

A

Meconium aspiration syndrome

53
Q

What pathology seen in neonates may cause a CXR to show hyperinflated lung fields with areas of collapse and consolidation, resulting in a patchy appearance?

A

Meconium aspiration syndrome

54
Q

What treatments can be given to neonates with meconium aspiration syndrome to maintain oxygen saturations and to help reduce pulmonary artery constriction?

A

Mechanical ventilation and surfactant

55
Q

What treatment can be given to babies with severe persistent pulmonary hypertension of the newborn to reduce pulmonary arterial pressures?

A

Inhaled nitric oxide

56
Q

Hypoxic ischaemic encephalopathy is diagnosed when?

A

When a term neonate shows neurological abnormalities

57
Q

How soon do the neurological abnormalities associated with hypoxic ischaemic encephalopathy develop?

A

They are noticeable at birth and develop over 72 hours

58
Q

A history of foetal distress in utero or during delivery, along with neurological features in the neonate is suggestive of what diagnosis?

A

Hypoxic ischaemic encephalopathy

59
Q

In neonates with hypoxic ischaemic encephalopathy, what investigation is carried out around day 7 to assess the location and extent of brain damage?

A

Brain MRI

60
Q

What treatment option can be used to reduce the effect of reperfusion injury in neonates with hypoxic ischaemic encephalopathy?

A

Therapeutic hypothermia

61
Q

If left untreated, neonatal jaundice can lead to what complication? This can cause what other problems?

A

Kernicterus- potentially leading to deafness and cerebral palsy

62
Q

Jaundice within what timeframe in a neonate is always abnormal?

A

The first 24 hours after birth

63
Q

What is the most common cause of unconjugated jaundice in a neonate?

A

Physiological jaundice

64
Q

Is breast milk jaundice in a neonate conjugated or unconjugated?

A

Unconjugated

65
Q

If a neonate has conjugated jaundice, what is the most important pathology to rule out?

A

Biliary atresia

66
Q

If treatment is required, what is first line for unconjugated neonatal jaundice?

A

UV phototherapy

67
Q

If UV phototherapy is not decreasing the bilirubin levels in a neonate with jaundice, what is the next line management option?

A

Exchange transfusion

68
Q

What investigation is used to rule out biliary atresia in a neonate with conjugated neonatal jaundice?

A

Abdominal ultrasound

69
Q

Physiological jaundice in neonates usually begins after 24 hours, peaks around day 5 and should return to normal by when?

A

2 weeks

70
Q

Jaundice in a term baby aged 2 weeks or more is known as what?

A

Prolonged jaundice

71
Q

Which babies are more prone to developing prolonged jaundice- breastfed or bottlefed neonates?

A

Breastfed

72
Q

An infection in a neonate is classed as post-natal if it occurs how long after delivery?

A

72 hours

73
Q

Which congenital infection causes severe anaemia leading to hydrops foetalis?

A

Parvovirus

74
Q

What is the most common organism causing perinatal infection of a neonate?

A

Group B strep

75
Q

How are peri and postnatal neonatal infections treated?

A

IV antibiotics

76
Q

What diagnosis should you suspect in a neonate with non-specific signs such as poor feeding, vomiting, jaundice, respiratory distress, irritability and sometimes seizures?

A

Neonatal infection

77
Q

When does maternal Grave’s disease affect a foetus? How is this treated?

A

The first 2 weeks of life- treated with anti-thyroid drugs

78
Q

What diagnosis should be considered in a neonate with tremors, a high-pitched cry and temperature instability?

A

Neonatal withdrawal

79
Q

Use of what drug during pregnancy is associated with stained teeth and hypoplasia of teeth enamel in the child?

A

Tetracyclines

80
Q

Use of what drug during pregnancy is associated with nasal hypoplasia and hypoplastic phalanges in the child?

A

Warfarin

81
Q

What structures herniate through the diaphragm in a congenital diaphragmatic hernia?

A

Liver, spleen and bowel

82
Q

Is congenital diaphragmatic hernia more common in boys or girls?

A

Boys

83
Q

What happens to the lungs in babies with congenital diaphragmatic hernia?

A

They are underdeveloped (pulmonary hypoplasia)

84
Q

How is congenital diaphragmatic hernia usually diagnosed?

A

On antenatal ultrasound

85
Q

How does a baby with congenital diaphragmatic hernia appear at birth?

A

Respiratory distress and a scaphoid (concave) abdomen

86
Q

What happens to heart and lung sounds in a baby with congenital diaphragmatic hernia?

A

There will be no breath sounds on the affected side and heart sounds may be displaced

87
Q

On radiography, loops of bowel in the thorax and mediastinal shift is suggestive of what diagnosis?

A

Congenital diaphragmatic hernia

88
Q

How are babies with congenital diaphragmatic hernia treated initially?

A

Ventilation and NG tube

89
Q

How is congenital diaphragmatic hernia treated definitively?

A

Surgical repair

90
Q

At what age should a cleft lip be repaired?

A

4 months

91
Q

At what age should a cleft palate be repaired?

A

1 year

92
Q

What happens in craniosynostosis?

A

Some of the sutures of the skull fuse prematurely

93
Q

At what age should the sutures of the skull fuse normally?

A

18-24 months

94
Q

What is the main clinical feature of craniosynostosis?

A

Abnormal head shape

95
Q

How is craniosynostosis treated?

A

Surgery

96
Q

What happens to a baby’s head if they have plagiocephaly?

A

Flattening on one side with protrusion on the opposite side

97
Q

What is the cause of positional plagiocephaly?

A

Lying on the affected side of the head preferentially

98
Q

What three groups of infants are at particular risk of hypoglycaemia as a neonate?

A

Those with diabetic mothers, those whose mothers have taken beta blockers and those with IUGR

99
Q

How is hypoglycaemia in a neonate prevented?

A

Feeding soon after birth and at regular intervals thereafter

100
Q

In neonates at risk of developing hypoglycaemia, glucose levels should be kept above what value?

A

2.6mmol/L

101
Q

If oral and NG feeds are not sufficient to treat hypoglycaemia, what other options can be considered?

A

Buccal or IV dextrose

102
Q

What diagnosis should always be considered in babies presenting shortly after birth with lethargy, poor feeding and abnormal neurological signs?

A

Inborn errors of metabolism

Child Health (10 decks)

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