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🍉paeds > neonatology > Flashcards

neonatology Flashcards

1
Q

how does a neonate present with sepsis?

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

RF for a baby to present with Sepsis?

A

PROM
Maternal pyrexia
Maternal GBS carriage

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3
Q

management of presumed sepsis in neonate?

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

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4
Q

commonest causes of neonatal sepsis

A 
group B strep
e.coli
Listeria
Coat-neg staphylococci (I lines in situ)
Haemophilus influenzae
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5
Q

group b strep sepsis?

how does it present?

A

Early onset – birth to 1 week
Late onset or recurrence – up to 3 months
Symptoms – may be non specific
May have no risk factors

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6
Q

ccx of group b strep sepsis?

A

Meningitis, DIC, pneumonia and respiratory collapse, hypotension and shock

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7
Q

what is done in TORCH screen? screen for congenital infection (infection acquired in the uterus by baby from mum)

A 
(T)oxoplasmosis, 
(O)ther Agents,
 (R)ubella 
(C)ytomegalovirus
(H)erpes Simplex.
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8
Q

what can TORCH result in>

A

Intrauterine growth restriction (IUGR), brain calcifications, neurodevelopmental delay, visual impairment, recurrent infections

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9
Q

signs u can see in congenital infection in a baby?

A

blueberry muffins rash- purple papullary rash–Rubella

microcephalous
deafness
heart defects\splenomegaly
bone abnormalities
rash
intrauterine growth restriction
anaemia
neutropenia
thrombocytopenia
hepatomegaly\jaundiced
hepatitis
pneumitis
cataracts
microphthalmia
retinites
intracerbral calcification
hydrocephalus
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10
Q

commonest reason for NUU admission

A

Resp distress (RDS)

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11
Q

causes of RDS?

A

Sepsis
TTN – transient tachypnoea of the newborn
Meconium aspiration

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12
Q

what is TTN?
symtoms?
pathophysiology?

Management?

A

Self limiting and common
Presents within 1st few hours of life

Grunting,
tachypnoea,
oxygen requirement, normal gases

Pathophysiology
Delay in clearance of foetal lung fluids

management:
Supportive, 
antibiotics,
 fluids,
 O2, 
airway support
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13
Q

What is meconium aspiration?

A

Meconium is inhaled into the lungs

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14
Q

sx of meconium aspiration

A 
Cyanosis, 
Increased work of breathing, 
grunting, 
apnoea,
 floppiness
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15
Q

RF for meconium aspiration

A

Post dates,
maternal diabetes,
maternal hypertension,
difficult labour

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16
Q

ix for meconium

A

Blood gas, septic screen, CXR

17
Q

how does TTN present on Xray?

A
  • fluid in horizontal fissure
  • wet lung
  • prominent vascular marking
18
Q

Treatment of Meconium aspiration?

A

suction below cords

airway support- intubation and ventilation

fluids and abx

surfactant

NO or ECMO

19
Q

Prognosis of meconium aspiration?

A

Most do well
some develop PPHN
there is associated mortality

20
Q

most likely causes of the ‘blue baby’ medical emergency

A

sepsis and respiratory causes more common than cardiac

21
Q

Investigation of the “blue baby”

A 
Examination and history
Sepsis screen
Blood gas and blood glucose
CXR
Pulse oximetry
ECG
Echo
(hyperoxia test)
22
Q

what are the cardiac ddx for the blue baby?

A 
TGA
Tetralogy of Fallots
TAPVD
Hypoplastic left heart syndrome
Tricuspid atresia
Truncus arteriosus
Pulmonary atresia
23
Q

what are the 5ts for cyanotic congenital cardiac disease (can cause blue baby)

A 
Truncus Arteriosus
TGA
Tricuspid Atresia
ToF
TAPVD
24
Q

Hypoglycaemia RF?

A

If requires admission to NNU may still manage with enteral feeds
Monitor blood glucose
Start iv 10% glucose
Increase fluids
Increase glucose concentration (central iv access)
Glucagon
Hydrocortisone

25
Q

what do if baby is hypothermia

A

If unable to maintain temperature on PNW admit and place in incubator
Sepsis screen and antibiotics
Consider checking thyroid function
Monitor blood glucose

26
Q

jaundiced baby management?

A

In severe jaundice may require admission for intensive phototherapy and/or exchange transfusion
Incubator and IV fluids may be required

27
Q

what is birth asphyxia?

A

Lack of oxygen at or around birth leads to multiorgan dysfunction

28
Q

what can cause birth asphyxia?

A 
Placental problem
Long, difficult delivery
Umbilical cord prolapse
Infection
Neonatal airway problem
Neonatal anaemia
29
Q

what are the 2 stages of asphyxia?

A

1st: Within minutes
Cell damage occurs with lack of blood flow and O2

2nd:
Reperfusion injury
Can last days or week.
Toxins are released from damaged cells

30
Q

management of birth asphyxia?

A

Cardiac support

Fluid restriction (avoid cerebral oedema)

Monitor for renal and liver failure

Respiratory support

Treat seizures

31
Q

neonatal surgical problems?

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

causes of failure to pass stool?

A

Large bowel atresia

Imperforate anus
+/- fistula

Hirschsprungs disease

Meconium plug

Meconium ileus
think cystic fibrosis

33
Q

Diaphragmatic hernia features?

A 
1 in 2500 births
90% on left
Male > female
Can be syndromic
Usually pulmonary hypoplasia
Intubation at birth
Respiratory support
Surgery 
(ECMO)
34
Q

what is Neonatal Abstinence Syndrome (NAS)

A 
Withdrawal from physically addictive substances taken by the mother in pregnancy
Opioids (methadone, heroin)
Benzodiazepines
Cocaine
Amphetamines
35
Q

how to monte/diagnose NAS?

A

Finnegan Scores

Urine toxicology

36
Q

treatment for NAS?

A

Comfort (e.g. swaddling)
Morphine
Phenobarbitone

37
Q

ccc of birth asphyxia>

A

Hypoxic-ischemic encephalopathy

cooling improves outcomes

38
Q

RR>60 or signs of respiratory distress are a common reason for admission- causes can be mild (TTN) or severe (MAS, sepsis)

A

.

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