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Paediatrics > Neonatology > Flashcards

Neonatology Flashcards

1
Q

symptoms of sepsis in neonates

A 
Baby pyrexia or hypothermia
Poor feeding
Lethargy or irritable
Early jaundice
Tachypnoea
Hypo or hyperglycaemia
Floppy
Asymptomatic
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2
Q

risk factors for neonatal sepsis (3)

A

PROM - membrane rupture
Maternal pyrexia
Maternal GBS carriage

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3
Q

management of presumed sepsis?

A
  • Admit NNU
  • (FBC, CRP, blood cultures) and blood gas
  • CXR, LP
  • fluid management to treat acidosis
  • monitor vital signs
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4
Q

antibiotics for sepsis?
1st line?
2nd line?

  • what do you add when there is abdominal concerns?
A

IV penicillin and gentamicin 1st line

  • line IV vancomycin and gentamicin

metronidazole

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5
Q

most common organism causing sepsis?

A 
Group B Streptococcus
E. coli
Listeria
Coag-neg Staphylococci (if lines in situ)
Haemophilus influenzae
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6
Q

GBS sepsis early onset vs late onset ?

complications (3)

A

Early onset – birth to 1 week
Late onset or recurrence – up to 3 months

  • Meningitis, DIC, pneumonia and respiratory collapse, hypotension and shock
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7
Q

congenital infection - TORCH screen

A 
Toxoplasmosis
Other (rubella, chicken pox, syphilis) 
Rubella (MMR virus)
Cytomegalovirus
HSV - acyclovir
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8
Q

congenital infection may result in (presentation) ?

A

IUGR (growth restriction), brain calcifications, neuro development delay, visual impairment, recurrent infections

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9
Q

rubella rash?

A

purple papular nodule rash

blue berry muffin rash

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10
Q

signs of respiratory distress?

- most common cause?

A

Grunting - expiring against partially close epiglottis! ,
- tachypnoea, oxygen requirement, normal gases

  • subcostal recessions!
  • TTN - Delay in clearance of foetal lung fluids
  • can also be caused from caesarian sections
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11
Q

Management of TTN?

A

Supportive, antibiotics, fluids, O2, airway support

- usually settles

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12
Q

signs in TTN - child XR

A

WET lungs- fluid in horizontal fisher

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13
Q

Meconium aspiration

A

fist stool passed by newborn - caused by stress during labour

  • inhaled into lungs
  • increased risk of pneumothorax, chemical pneumonitis
  • reduces surfactant, chest infections
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14
Q

risk factors for Meconium aspiration

A

Post term dates, maternal diabetes, maternal hypertension, difficult labour

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15
Q

symptoms of Meconium aspiration

A

Cyanosis, increased work of breathing, grunting, apnoea, floppiness

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16
Q

Investigations of Meconium aspiration?

A

Blood gas, septic screen, CXR

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17
Q

CXR signs of Meconium aspiration?

A
  • flattened diaphragm - hyperinflation of the chest

- patchy areas of collapse

18
Q

treatment of Meconium aspiration?

A

endotracheal tube - suction below cords

  • airway support - ventilation and intubation
  • fluids and anti b’s IV
  • surfactant
  • NO or ECmO
19
Q

some babies with Meconium aspiration GO ON TO DEVELOP?

A

PPHN

- right to left shunt across PFO/PDA

20
Q

Investigation of the “blue baby” (8)

A 
Examination and history
Sepsis screen
Blood gas and blood glucose
CXR
Pulse oximetry
ECG
Echo
(hyperoxia test)
21
Q

the 5 T’s of congenital heart disease

  • the other 2?
A 
truncus arteriosus 
TGA 
Tricuspid arteriosus 
TOF
TAPVD
  • Hypoplastic Left heart syndrome
  • pul atresia
22
Q

Hypoglycaemia - management?

A
  • Monitor blood glucose
  • Start iv 10% glucose
  • Increase fluids
  • Increase glucose concentration (central iv access)
  • Glucagon
  • Hydrocortisone
23
Q

islet cell hyperplasia affects?

A
  • babies from diabetic mothers

- blood glucose drops

24
Q

Hypothermia - if babies are unable to maintain temperature, what are some of the reasons why?

A

hot cot-incubator

  • sepsis screen and antibiotics
  • congenital hypothyroidism
  • monitor blood glucose
25
Q

Birth asphyxia is what?

A

lack of oxygen at or around both - leads to multi organ dysfunction

26
Q

Causes of Birth asphyxia? (6)

A
  • Placental problem - abruption
  • Long, difficult delivery
  • Umbilical cord prolapse
  • Infection
  • Neonatal airway problem
  • Neonatal anaemia
27
Q

Stages of birth asphyxia - first

A

within minutes

cell damage occurs with lack of blood flow and O2

28
Q

Stages of birth asphyxia - second

A
  • Reperfusion injury
  • Can last days or weeks
    toxins are released from damaged cells
29
Q

what brain injury occurs secondary to birth asphyxia?

A

Hypoxic Ischaemic encephalopathy

  • cord blood gasses - blood gas after delovery
  • low tone, reduced conscious levels, seizures
30
Q

Management of Hypoxic Ischaemic encephalopathy

A

Therapeutic hypothermia - 33-34 - improves neuro outcome

  • treat seizures
  • fluid restriction
  • monitor renal and liver failure
  • resp support
  • cardiovascular support
31
Q

Surgical problems - give some examples? (5)

A
  • Oesphageal atresia/fistula
  • Duodenal atresia and other GI atresias - polyhydramunous
  • Causes of failure to pass stool
  • Abdominal wall defects
  • Diaphragmatic hernia
32
Q

causes of failure to pass stool in new borns?

A
  • Large bowel atresia
  • Imperforate anus
    +/- fistula
  • Hirschsprungs disease
  • Meconium plug
  • Meconium ileus
    think cystic fibrosis - CFDR- reduced sodium and water - thick meconium
33
Q

congenital diaphragmatic hernia ?

- what sex is it more common in?

A

defect in diaphragm, bowel contents herniate up into the chest

  • males
  • 90% are on the left
34
Q

congenital diaphragmatic hernia.. consequences?

A
  • Usually pulmonary hypoplasia
  • Intubation at birth
  • mortality associated
35
Q

Neonatal Abstinence Syndrome (NAS) - what are the most common substances?

A

Opioids (methadone, heroin)
Benzodiazepines
Cocaine
Amphetamines

36
Q

Neonatal Abstinence Syndrome (NAS)- give some examples of material co-morbidity?

A

smoking, alcohol, BBV, ill health

37
Q

Monitoring and Treatment of Neonatal Abstinence Syndrome (NAS)?

A

Finnegan scores
Urine toxicology

Comfort (e.g. swaddling)
Morphine - isolated opioid use
Phenobarbitone - polydrug abuse

38
Q

What are some features of finnegans score?

A

CNS distrubance - high pitch cries

  • sleeping problems
  • tremor
  • high tone
  • AUTONOMIC
  • temp instability
  • yawning, sneezing, sweating

GI
- diarrhoea

39
Q

First line treatment for neonatal seizure

A

Phenobarbitone

- CNS depressant

40
Q

RR sign of resp rate?

A

> 60

Paediatrics (49 decks)

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