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Neonatology Flashcards

1
Q

Presentation of RDS in neonates?

A

Hours after birth, tachypnoea over 60, indrawing/retraction/recession, grunting, nasal flaring, cyanosis

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2
Q

predisposing factors for RDS?

A

prematurity, male, white, maternal diabetes, CS, hypothermia, second twin

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3
Q

How will RDS lungs appear on xray?

A

ground glass appearance, air bronchogram

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4
Q

If a fetus is found to have RDS in utero, what dose frequency of betamethasone is given and how soon after if delivery of baby?

A

2 doses, 12 hours apart then 24 hours later give birth

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5
Q

Purpose of erythromycin in pre term delivery?

A

Can delay labour by 2 weeks

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6
Q

When is erythromycin useful?

A

Premature rupture of membranes

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7
Q

Why are tocolytics useful when given alongside steroids?

A

Allow maximum effect of the steroids

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8
Q

Other than oxygen delivery, what is the main post natal care support needed in RDS?

A

Temperature regulation

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9
Q

how does transient tachpnoea of the newborn differ to RDS?

A

more mature babies, 100-120/min, no grunting or indrawing, settles in 24-48 hours

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10
Q

Causes of transient tachpnoea of the newborn?

A

Increased fluid production by lungs, delayed fluid clearance

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11
Q

What usually clears the lungs of fluid before labour and how does this relate to predisposing factors of TTN?

A

Catecholeamine surge clears fluid, CS is predisposing factor along with induction before term

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12
Q

How does transient tachypnoea of the newborn appear on xray?

A

Fluid in horizontal fissures, congested pulmonary venous congestion, wet lung

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13
Q

2 supportive management options for transient tachypnoea of the newborn?

A

oxygen and parental nutrition (too breathless to feed)

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14
Q

Differentials for transient tachypnoea of the newborn and how this effects management?

A

pneumoniae and cardiac disease which usually leads to antibiotics being administered before TTN can be diagnosed

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15
Q

After birth what do the following become:
ductus venosus
umbilical vein
umbilical artery

A

ligamentum venosum
ligamentum teres
medial umbilical ligaments

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16
Q

What type of shunt appears in PPH of the newborn? causes symptoms?

A

right to left, severe hypoxia, tricuspid regurg, poor flow through pulmonary artery

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17
Q

What can cause PPH of the newborn to occur?

A

Congenital pneumoniae, meconium aspiration syndrome, infection, diaphragmatic hernia, acidotic or asphyxiated

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18
Q

4 things to manage a baby with PPH of the newborn?

A
  1. maintain BP- inotropic support
  2. oxygen support - high frequency oscillation ventilation
  3. stop baby moving - paralysing drugs and minimal handling
  4. Vasodilate pulmonary vessels - NO, tolazoline, prostacyclin, MgSO4
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19
Q

What 4 vasodilators can be given in a newborn suffering PPH?

A

prostacyclin, MgSO4, NO, tolazoline

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20
Q

what 3 conditions can cause a fetus to pass meconium before they are born?

A

Asphyxiated, stressed or acidotic

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21
Q

What 6 effects can meconium aspiration syndrome have on the lungs and the newborn in general?

A

Ball valve effect where air can get passed meconium and overinflates certain areas, pneumothorax, bacterial superinfection, pneumonitis, RDS, surfactant inhibition

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22
Q

How does meconium aspiration syndrome appear on x-ray?

A

overinflated areas, patchy opacification, pneumothoraces

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23
Q

management of meconium aspiration syndrome?

A

prevention, paralysis and ventilation, surfactant lavage, antibiotics

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24
Q

Cause of bronchopulmonary dysplasia?

A

Chorioamnionitis causing inflammation, remodelling and fibrosis

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25
How are babies who suffer bronchopulmonary dysplasia usually born? requirements?
Very preterm and need ventilation
26
What do babies who suffered bronchopulmonary dysplasia usually develop? why?
emphysema due to damage caused by interventions needed in early life to keep them alive
27
3 findings on xray of a baby with bronchopulmonary dysplasia?
hazy opacification, cyst formation, overinflated areas
28
How can oxygen damage to lungs be prevented in babies with bronchopulmonary dysplasia?
HFOV, off oxygen quickly even in hypercapnic states, surfactant replacement, nutrition, diuretics,
29
What can bile be converted to by bacteria within the intestine (2)?
stercobilin or urobilinogen
30
What is urobilinogen excreted as by the kidneys?
Urobilin
31
How does bilirubin travel in the blood and why?
Albumin as water insoluble
32
What enzyme converts bilirubin in the liver?
glucuronyl transferase
33
3 main mechanisms that can cause jaundice?
Increased red cell breakdown, reduced conjugation in the liver, biliary obstruction
34
What is the level of SBR measured in?
umol/l
35
what do tests total and direct SBR allow for calculation of?
``` Total = conjugated and unconjugated Direct = conjugated ```
36
2 predisposing factors for physiological jaundice in first few days of life?
Raised Hb (usually 18-20g/dL in newborns) and relative dehydration in newborns
37
does breast milk lead to increased conjugated or unconjugated bilirubin?
unconjugated
38
How long does jaundice caused by breast milk usually last?
2/3 weeks, rarely longer than 2/3 months
39
What is it present in breast milk that produces neonatal jaundice and why?
Beta-glucoronidase prevents bilirubin binding to albumin
40
3 causes of neonate developing polycythaemia?
TTTS, diabetic mother, IUGR
41
What type of bruising on the head of a neonate can occur with excess RBC breakdown?
Cephalohaematoma
42
What is Criggler-Najjar syndrome that causes jaundice?
Deficient glucuronyl transferase
43
5 Endocrine/IEM causes of jaundice in newborns?
tyrosinaemia, galactosaemia, hypo thyroidism, hypopituitarism, hypoadrenalism
44
If a baby appears ill and jaundiced what do you immediately suspect the cause to be?
Sepsis
45
What is erythroblastosis fetalis and what causes it?
process of haemolytic anaemia in the womb cause by rhesus disease where erythroblasts present in blood stream
46
What is hydrops fetalis and what occurs as a result of it?
Severe fetal anaemia, high output cardiac failure, accumilation of fluid in lungs, tissues, heart, ascites
47
What investigations are usually performed into early neonatal jaundice? (inc a test for autoantibodies of RBC)
SBR (total and direct), sepsis screen for TORCH, Coombs test, blood group, FBP, G-6PD deficiency
48
2 enzyme deficiencies that can lead to haemolysis and jaundice?
G-6PD deficiency or pyruvate kinase
49
Causes of conjugated forms of jaundice in newborn?
Neonatal hepatitis syndrome, hep A/B/C, biliary atresia, choledochal cyst, inspissated bile, alagille syndrome, prolonged TPN
50
What can cause neonatal hepatitis syndrome?
CF, alpha 1 antitrypsin deficiency, sepsis, TORCH, galactosaemia, tyrosinosis, hypermethioninaemia
51
How do you investigate biliary atresia?
HIDA scan - radioisotope
52
What procedure is needed for biliary atresia?
Kasai procedure
53
When is the appearance of jaundice abnormal..?
day 1 after delivery and lasting for more than 14 days
54
Blood and urine investigations into cholestasis?
Alpha1 antitrypsin levels, TORCH screen, FBP, LFT, urine organic acids and amino acids, blood culture, fasting glucose/lactate/AA
55
When is an USS on the gallbladder and biliary tree best performed?
Fasting for 4 hours
56
What is given 3 days before a HIDA scan and what dosage?
Phenobarbitone 5mg/kg/day
57
What can occur as a complication of raised bilirubin?
Kernicterus
58
What happens in kernicterus
bilirubin deposits in basal ganglia and leads to bilirubin encephalopathy
59
Symptoms of kernicterus and specifically bilirubin encephalopathy?
Back arching, high pitched cry, lethargy, abnormal tone
60
What morbidities can develop from kernicterus?
cerebral palsy, sensorineural deafness, visual impairments
61
What does phototherapy convert bilirubin into and why is this able to be eliminated from circulation?
lumirubin but structural isomerisation causing unconjugated to become water soluble
62
How much blood volume is usually used in exchange transfusions?
twice the babies blood volume
63
What 4 conditions warrant an exchange transfusion over phototherapy?
if there are electrolyte imbalances, low BP, thrombocytopenia, hypoglycaemia
64
Define sensitivity?
ability of a test to identify those who have the disease
65
Define specificity?
Ability of a test to correctly identify those who dont have the disease
66
If it has high sensitivity what does this mean?
Picks up all those who have the disease
67
If it has high specificity what does that mean?
excludes all those who dont have the disease
68
When is heel prick testing performed on new borns?
Day 5 usually (5-8)
69
name 6 conditions that are screened for in newborns?
PKU, MCADD, congenital hypothyroidism, sickle cell, CF, homocystinuria
70
What is the inheritance pattern of PKU?
autosomal recessive
71
What is lacking in PKU?
The enzyme to convert phenylalanine into tyrosine
72
What is phenylalanine broken down into in those suffering PKU and how is it excreted?
Broken down into phenyl ketones excreted in urine
73
What damage can PKU cause to an individual?
Mental retardation, epilepsy, seizures, behavioural issues
74
What cannot be generated in a neonate suffering with MCADD?
cannot generate ketones
75
What does MCADD lead to?
hypoglycaemia, hepatic encephalopathy, sudden infant death syndrome
76
Management of MCADD?
avoid fasting, measure levels during illness and stress management
77
2 reasons that steroids are given to babies preterm?
Prevent RDS and intrraventricular haemorrhage
78
Why is MgSO4 given to babies preterm?
protects neurodevelopmental outcomes
79
5 things looked at on the apgar score?
HR, RR, muscle tone, reflexes, colour
80
How is apgar scored for each category?
HR - absent (0), below 100 (1), above 100 (2) RR - absent (0), slow (1), normal/fast (2) Muscle tone - limp (0), decreased (1), normal (2) Reflexes - absent (0), decreased (1), normal (2) Colour - blue (0), pink with blue extremities (1), pink (2)
81
What can and cannot be interpretted on a capillary blood gas compared to an arterial blood gas?
CBG can gain correct information on pCO2, pH and HCO3 but not pO2
82
Which thoracic vertebrae should the endotracheal tube be found between?
T1 and T3
83
2 signs of tension pneumothorax on xray?
Decreased lung markings and tracheal deviation
84
How do you manage a pneumothorax?
Needle thoracocentesis followed by chest drain insertion
85
What can be applied to the chest wall to identify pneumothorax in an neonate?
Translumination with fibreoptic light
86
What 3 things are given to avoid osteopenia of the newborn?
Phosphate, vitamin D and calcium
87
What are the fluid requirements for preterm neonates on day 1/2/3/4/5 after birth?
``` 1 - 60ml/kg/day 2 - 80ml/kg/day 3 - 100ml/kg/day 4 - 120ml/kg/day 5 - 150ml/kg/day ```
88
When and how do neonates usually recieve immunity?
IgG maternal transfer in 3rd trimester
89
If a neonate develops jaundice within 24 hours of birth what are the 5 most likely causes?
Rhesus incompatibility, ABO incompatibility, Spherocytosis, congenital infection, g6PD deficiency
90
If a neonate develops jaundice 2 days to 3 weeks of age what are the 4 most likely causes?
physiological, breast milk jaundice, infection or crigler najar syndrome
91
If a neonate has jaundice past 3 weeks of age are you worries?
yeah - any of above conjugated and unconjugated causes throughout this flashcard set
92
3 main side effects of phototherapy the neonate may experience?
inability of temperature regulation, macular rash, bronze discolouration to skin
93
Why can a faint systolic murmur be heard in early life?
patent ductus arteriosus
94
If a baby is symptomatic with patent ductus arteriosus what 3 things can you give to close the duct?
Prostaglandin synthetase inhibitors, indomethecin, ibuprofen
95
What can be given to prevent apnoea?
Caffeine
96
Established neonate on enteral feeds 1 week later stops tolerating feeds, aspirating large volumes and distended abdomen, what is initial diagnosis?
necrotizing enterocolitis
97
What long terms complications of prematurity can arise?
retinopathy of prematurity, hearing impairments, bronchopulmonary dysplasia and emphysema, neurodevelopmental issues (CP/learning difficulties/behvioural/fine motor/poor attention span/delayed language)

Paediatrics (20 decks)

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