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MB2: Child health > Neonatology > Flashcards

Neonatology Flashcards

1
Q

what age is preterm baby

A

<37wks

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2
Q

what age is a term baby

A

> 37wks and <41wks

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3
Q

what age is a post term baby

A

> 41 wks

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4
Q

normal birth weight

A

2.5-4kg

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5
Q

overweight birth weight?

A

> 4kg

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6
Q

underweight birth weight?

A

<2.5kg

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7
Q

features to ask about labour/birth?

A

spontaneous/induced
cephalic/breech?
C section?

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8
Q

describe oygen supply to the foetus during birth

A

has a rich supply of Hb in the blood

labour is hypoxic and so foetal Hb helps release O2 when needed

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9
Q

what may lead to lowered fHb leading to hypoxia during labour

A

smoking
pre-eclampsia
prolonged labour

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10
Q

describe some features o perinatal adaptation straight after birth

A 
first breath 
alveolar expansion 
change form foetal to adult circulation 
decreased pulmonary artery pressure 
increased PO2
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11
Q

what is the apgar score

A

objective score of perinata adaptation

>8 is healthy

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12
Q

why is skin to skin contact important for neonate

A

forms attachment with neonate to mother

hormonal and emotional response

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13
Q

true/false - term infants typically have a low calorie intake in the first 24 hours

A

true

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14
Q

potential complications/features of haemorrhagic disease of the newborn

A

GI bleed
intracranial haemorrhage
epistaxis

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15
Q

preventing haemorrhagic disease of the newborn?

A

IM vitamin K

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16
Q

when would you give heb B vaccine

A

usually given as part of routine but if mother has it with high viral load then may be immediate
severe- hep B Ig

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17
Q

risk of HIV/hep C to newborn if there is low viral load?

A

minimal

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18
Q

when would you immediately offer the BCG vaccine

A

if it is an at risk family for TB

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19
Q

routine vaccination antenatal and postnatal

A

maternal influenza and pertussis
routine vaccine at 8 weeks
hep B at routine or birth and BCG if needed

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20
Q

what is screened for on newborn screening card and what day is it done

A 
day 5 
CF 
hypothyroidism 
haemoglobinopathies 
metabolic conditions
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21
Q

what to do if CF is +ve on newborn screening card

A

sweat test

genetic screening

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22
Q

parental habits to advise to promote health

A 
smoking 
alcohol
drug use 
diet 
social interaction 
feeding 
vaccination 
sleep position 
baby box
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23
Q

components of the apgar score

A 
pulse 
respiration 
appearance 
grimace 
activity
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24
Q

normal Resp rate of a neonate

A

40-60 resp/min

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25
Q

normal HR of a neonate

A

120-140BPM

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26
Q

key things to assess in a sick infant?

A 
HR and RR
BP
work of breathing 
CRT
colour 
SaO2 
jaundice 
tone 
vomit
feed
growth
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27
Q

key parts of maternal hx to consider in sick infant?

A

PMHx
issues
delivery
drugs

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28
Q

initial management of sick term infant?

A 
temp
airway and breathing with O2 
fluids and inotropes 
glucose and acid base 
abx if needed
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29
Q

what is hypoxic ischaemic encephalopathy

A

multi organ system damage due to tissue hypoxia

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30
Q

birth related respiratory conditions

A

hypoxic ischaemic encephalopathy
TTN
PTX

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31
Q

birth related cardiac conditions

A

PPHN

heart failure due to rh disease, chromosome, hydrops foetalis

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32
Q

congenital neuro conditions

A

myotonic dystrophy

spina bifida

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33
Q

congenital resp conditions

A

diaphragmatic hernia

TOF

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34
Q

congenital cardiac conditions

A 
tetrology of fallot 
transposition of great arteries 
HLHS
aortic coarctation 
TAVPD
ASD/VSD
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35
Q

sites of infection in neonate

A 
CNS 
resp 
skin, bone
GI
GU
Blood
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36
Q

bacterial causes of infection in neonate

A 
syphilis 
listeria 
staph aureus/epidemidis 
e coli
group b strep
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37
Q

viral causes of infection in neonate

A 
HIV
toxoplasma 
parovirus
herpes
enterovirus 
CMV
rubella
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38
Q

what is a moderate preterm infant

A

32-37 weeks

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39
Q

what is a very preterm infant

A

28-32 weeks

40
Q

what is an extremely preterm infant

A

<28 weeks

41
Q

factors increasing chance of infant mortality in first year of life

A

low birth weight

preterm delivery

42
Q

what has lead to increase in premature babies over years

A

increasing maternal age
increased rate of complication
more c section
greater infertility treatment

43
Q

risk factors for prematurity

A 
twins 
>2 preterm babies 
older age 
IVF
smoking, drugs, alcohol
abnormal uterus 
<6m between pregnancies 
poor nutrition, high blood pressure, diabetes
44
Q

what risks to pregnancy does smoking carry

A

premature birth

miscarriage

45
Q

true/false - babies <30wks are managed the same a term babies

A

false - babies 31-33 can be managed similarly, or not, and >33 weeks are managed similar
<30 weeks need more intense management

46
Q

causes of hypothermia in preterm neonates

A

low BMR
little s/c fat
low muscle activity
high surface area

47
Q

methods of heat loss in preterm neonates

A

conduction
radiation
convection
evaporation

48
Q

management of heat loss in preterm neonates

A 
wrap/bags 
hat 
transwarmer mattress 
prewarmed incubator 
skin to skin care
49
Q

increased risk of growth and nutritional compromise in preterm?

A

lower reserves
gut immaturity
immature metabolic pathways
increased nutritional demand

50
Q

why are preterm neonates at increased risk of sepsis

A

indwelling lines
intensive care
immature immune system

51
Q

causes of NRDS

A

structural immaturity
alveolar damage from exudate
surfactant deficiency
secondary pathology

52
Q

how common is NRDS

A

75% <29wks

10% 32 weeks

53
Q

clinical features NRDS

A 
tachypnoea 
increased work of breathing 
intercostal/subcostal recession 
cyanosis 
nasal flare 
grunting
54
Q

management of NRDS

A

antenatal sreroids - dexamethasone/betamethasone
surfactant replacement
ventilation - CPAP or ET tube

55
Q

physiological action of ductus arteriosus

A

umbilical blood passes into RA ad crosses foramen ovale to enter aorta or by pulmonary artery to aorta
at birth foramen ovale should close and ductus arteriosus should also close to create adult circulation

56
Q

how many suffer neurodevelopmental delay and mortality in grade 1/2 intraventricular haemorrhage

A

20%

10% mortality

57
Q

how many suffer neurodevelopmental delay and mortality in grade 3/4 intraventricular haemorrhage

A

80%

50%

58
Q

best way to prevent necrotising enterocolitis

A

breastfeeding

59
Q

pathophysiology of necrotising enterocolitis

A

major haemodynamic instability and gut ischaemia, leading to gut flora invading the circulatory system

60
Q

late metabolic complications of preterm infants?

A

osteopaenia of pregnancy

61
Q

early metabolic complications of preterm infants

A

hypoglycaemia

hyponatraemia

62
Q

survival at 22 weeks

A

6%

63
Q

survival at 23 weeks

A

33%

64
Q

survival at 26%

A

85%

65
Q

how can CF in neonates lead to bowel obstruction

A

meconium may build up due to being sticky and can lead to obstruction

66
Q

how may jejunal atresia appear on x ray and how is it managed

A

high obstruction in jejunum with collapse of the distal bowel loops
surgeryt

67
Q

describe how malrotation can lead to bowel obstruction

A

congenital malrotation leads to a low DJ flexure in the bowel, with a high caecum
this is prone to volvulus, leading to ischaemia and death of the bowel

68
Q

risk factors for hypoglycaemia in neonates?

A

small birth weight
low temp
mothers diabetic status

69
Q

presentation of neonatal hypoglycaemia

A 
seizure 
jittery 
sleepy 
high pitched cry 
hypothermia
70
Q

risk factors for severe jaundice

A 
prematurity 
materal ab 
blood group difference 
brusing at delivery 
infection
71
Q

investigation of jaundice in neonates

A

bilirubin
if treatment required check FBC and antibodies/blood group
if sepsis concern then CRP

72
Q

cause of tachypnoea and what is tachypnoea

A 
RR>60 
infection 
NRDS 
TTN
too hot 
meconium aspiration 
PPHN 
NAS 
necrotising enterocolitisi
73
Q

describe the physiological jaundice seen in term neonates

A

increased bili due to increased Haem breakdown
decreased uptake and binding in liver so decreased conjugation
decreased excretion so builds up in enterohepatic circulation

74
Q

causes of pathological jaundice <24hr

A

haemolysis

hepatitis

75
Q

causes of haemolysis leading to jaundice

A

ABO mismatch
Rh ab
sepsis
enzyme/cell membrane defects

76
Q

true/false - jaundice <24hr is always pathological

A

true

77
Q

if there is a high conjugated bilirubin, what is the likely cause of the jaundice

A

hepatitis

78
Q

investigating pathological jaundice?

A 
TSB
maternal blood group and Ab if Rh -ve 
baby blood group and coombs test 
elution test 
FBC 
CRP/culture
79
Q

what is coombs test

A

direct antiglobulin test to look for autoimmune haemolytic anaemia

80
Q

what is elution test

A

testing dirtectly for anti-A or anti B on RBC

81
Q

cause of high bilirubin 24hr to 10days

A 
milk dehydration 
haemolysis 
cephalohaematoma, bruising, CNS haemorrhage, swallowed blood 
polycythaemia 
infection 
increased enterohepatic recycling 
haemolysis
82
Q

true/false - high bilirubin 24hr-10d is always pathological

A

false

83
Q

cause of persistent >14d unconjugated bilirubinaemia

A 
breast milk jaundice 
poor milk intake 
haemolysis 
infection 
hypothyroid
84
Q

treu/false - persistent unconjugated bilirubinaemia is always pathological

A

false - not always but should be investigated in case

85
Q

true/false- persistent conjugated hyperbilirubinaemia is always pathological

A

true

86
Q

cause of persistent conjugated hyperbilirubinaemia

A

hepatitis

biliary atresia

87
Q

causes of neonatal hepaittis

A 
toxoplasmosis 
rubella 
CMV
herpes 
syphilis 
HIV
varicella 
listeria 
metabolic disorders 
biliary atresia
88
Q

typical features of physiological jaundice

A

staerts day 2, peaks day 5
resolves by day 14
otherwise well

89
Q

typical features pathological jaundice

A

onset day 1
prolonged past 14
colour of stool and urine
high conjugated bili

90
Q

what % of babies have physiological jaundice

A

60%, 10% will still be at 1m

91
Q

what is kernicterus

A

unconjugated bili is toxic to the brain ans can cross the BBB in infancy

92
Q

presentation of kernicterus

A 
lethargy 
poor feed 
seizure 
spasticity 
hypotonia 
arching of neck, back, head 
temp instability
93
Q

risk of developing kernicterus

A

high unconj bili >340 or<300 in preterm

asphyxia, acidosis, hypoxia, hypothermia, sepsis, meningitis, decreased alb binding

94
Q

treatment of jaundice

A 
treat cause 
hydration 
phototherapy 
exchange transufsion - rare 
IV Ig for isoimmune haemolytic disease with rising bili despite phototherapy OR within 30-50 of needing exchange transfusion
95
Q

how to rehydrate as part of treatment for jaundice?

A

oral feed
breastfed - 8-12 times daily
if formula fed then it should be formula or expressed milk and not water

MB2: Child health (12 decks)

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