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Paediatrics > Neonatology > Flashcards

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
Q

How are babies who suffer bronchopulmonary dysplasia usually born? requirements?

A

Very preterm and need ventilation

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26
Q

What do babies who suffered bronchopulmonary dysplasia usually develop? why?

A

emphysema due to damage caused by interventions needed in early life to keep them alive

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27
Q

3 findings on xray of a baby with bronchopulmonary dysplasia?

A

hazy opacification, cyst formation, overinflated areas

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28
Q

How can oxygen damage to lungs be prevented in babies with bronchopulmonary dysplasia?

A

HFOV, off oxygen quickly even in hypercapnic states, surfactant replacement, nutrition, diuretics,

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29
Q

What can bile be converted to by bacteria within the intestine (2)?

A

stercobilin or urobilinogen

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30
Q

What is urobilinogen excreted as by the kidneys?

A

Urobilin

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31
Q

How does bilirubin travel in the blood and why?

A

Albumin as water insoluble

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32
Q

What enzyme converts bilirubin in the liver?

A

glucuronyl transferase

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33
Q

3 main mechanisms that can cause jaundice?

A

Increased red cell breakdown, reduced conjugation in the liver, biliary obstruction

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34
Q

What is the level of SBR measured in?

A

umol/l

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35
Q

what do tests total and direct SBR allow for calculation of?

A 
Total = conjugated and unconjugated
Direct = conjugated
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36
Q

2 predisposing factors for physiological jaundice in first few days of life?

A

Raised Hb (usually 18-20g/dL in newborns) and relative dehydration in newborns

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37
Q

does breast milk lead to increased conjugated or unconjugated bilirubin?

A

unconjugated

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38
Q

How long does jaundice caused by breast milk usually last?

A

2/3 weeks, rarely longer than 2/3 months

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39
Q

What is it present in breast milk that produces neonatal jaundice and why?

A

Beta-glucoronidase prevents bilirubin binding to albumin

40
Q

3 causes of neonate developing polycythaemia?

A

TTTS, diabetic mother, IUGR

41
Q

What type of bruising on the head of a neonate can occur with excess RBC breakdown?

A

Cephalohaematoma

42
Q

What is Criggler-Najjar syndrome that causes jaundice?

A

Deficient glucuronyl transferase

43
Q

5 Endocrine/IEM causes of jaundice in newborns?

A

tyrosinaemia, galactosaemia, hypo thyroidism, hypopituitarism, hypoadrenalism

44
Q

If a baby appears ill and jaundiced what do you immediately suspect the cause to be?

A

Sepsis

45
Q

What is erythroblastosis fetalis and what causes it?

A

process of haemolytic anaemia in the womb cause by rhesus disease where erythroblasts present in blood stream

46
Q

What is hydrops fetalis and what occurs as a result of it?

A

Severe fetal anaemia, high output cardiac failure, accumilation of fluid in lungs, tissues, heart, ascites

47
Q

What investigations are usually performed into early neonatal jaundice? (inc a test for autoantibodies of RBC)

A

SBR (total and direct), sepsis screen for TORCH, Coombs test, blood group, FBP, G-6PD deficiency

48
Q

2 enzyme deficiencies that can lead to haemolysis and jaundice?

A

G-6PD deficiency or pyruvate kinase

49
Q

Causes of conjugated forms of jaundice in newborn?

A

Neonatal hepatitis syndrome, hep A/B/C, biliary atresia, choledochal cyst, inspissated bile, alagille syndrome, prolonged TPN

50
Q

What can cause neonatal hepatitis syndrome?

A

CF, alpha 1 antitrypsin deficiency, sepsis, TORCH, galactosaemia, tyrosinosis, hypermethioninaemia

51
Q

How do you investigate biliary atresia?

A

HIDA scan - radioisotope

52
Q

What procedure is needed for biliary atresia?

A

Kasai procedure

53
Q

When is the appearance of jaundice abnormal..?

A

day 1 after delivery and lasting for more than 14 days

54
Q

Blood and urine investigations into cholestasis?

A

Alpha1 antitrypsin levels, TORCH screen, FBP, LFT, urine organic acids and amino acids, blood culture, fasting glucose/lactate/AA

55
Q

When is an USS on the gallbladder and biliary tree best performed?

A

Fasting for 4 hours

56
Q

What is given 3 days before a HIDA scan and what dosage?

A

Phenobarbitone 5mg/kg/day

57
Q

What can occur as a complication of raised bilirubin?

A

Kernicterus

58
Q

What happens in kernicterus

A

bilirubin deposits in basal ganglia and leads to bilirubin encephalopathy

59
Q

Symptoms of kernicterus and specifically bilirubin encephalopathy?

A

Back arching, high pitched cry, lethargy, abnormal tone

60
Q

What morbidities can develop from kernicterus?

A

cerebral palsy, sensorineural deafness, visual impairments

61
Q

What does phototherapy convert bilirubin into and why is this able to be eliminated from circulation?

A

lumirubin but structural isomerisation causing unconjugated to become water soluble

62
Q

How much blood volume is usually used in exchange transfusions?

A

twice the babies blood volume

63
Q

What 4 conditions warrant an exchange transfusion over phototherapy?

A

if there are electrolyte imbalances, low BP, thrombocytopenia, hypoglycaemia

64
Q

Define sensitivity?

A

ability of a test to identify those who have the disease

65
Q

Define specificity?

A

Ability of a test to correctly identify those who dont have the disease

66
Q

If it has high sensitivity what does this mean?

A

Picks up all those who have the disease

67
Q

If it has high specificity what does that mean?

A

excludes all those who dont have the disease

68
Q

When is heel prick testing performed on new borns?

A

Day 5 usually (5-8)

69
Q

name 6 conditions that are screened for in newborns?

A

PKU, MCADD, congenital hypothyroidism, sickle cell, CF, homocystinuria

70
Q

What is the inheritance pattern of PKU?

A

autosomal recessive

71
Q

What is lacking in PKU?

A

The enzyme to convert phenylalanine into tyrosine

72
Q

What is phenylalanine broken down into in those suffering PKU and how is it excreted?

A

Broken down into phenyl ketones excreted in urine

73
Q

What damage can PKU cause to an individual?

A

Mental retardation, epilepsy, seizures, behavioural issues

74
Q

What cannot be generated in a neonate suffering with MCADD?

A

cannot generate ketones

75
Q

What does MCADD lead to?

A

hypoglycaemia, hepatic encephalopathy, sudden infant death syndrome

76
Q

Management of MCADD?

A

avoid fasting, measure levels during illness and stress management

77
Q

2 reasons that steroids are given to babies preterm?

A

Prevent RDS and intrraventricular haemorrhage

78
Q

Why is MgSO4 given to babies preterm?

A

protects neurodevelopmental outcomes

79
Q

5 things looked at on the apgar score?

A

HR, RR, muscle tone, reflexes, colour

80
Q

How is apgar scored for each category?

A

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
Q

What can and cannot be interpretted on a capillary blood gas compared to an arterial blood gas?

A

CBG can gain correct information on pCO2, pH and HCO3 but not pO2

82
Q

Which thoracic vertebrae should the endotracheal tube be found between?

A

T1 and T3

83
Q

2 signs of tension pneumothorax on xray?

A

Decreased lung markings and tracheal deviation

84
Q

How do you manage a pneumothorax?

A

Needle thoracocentesis followed by chest drain insertion

85
Q

What can be applied to the chest wall to identify pneumothorax in an neonate?

A

Translumination with fibreoptic light

86
Q

What 3 things are given to avoid osteopenia of the newborn?

A

Phosphate, vitamin D and calcium

87
Q

What are the fluid requirements for preterm neonates on day 1/2/3/4/5 after birth?

A 
1 - 60ml/kg/day
2 - 80ml/kg/day
3 - 100ml/kg/day
4 - 120ml/kg/day
5 - 150ml/kg/day
88
Q

When and how do neonates usually recieve immunity?

A

IgG maternal transfer in 3rd trimester

89
Q

If a neonate develops jaundice within 24 hours of birth what are the 5 most likely causes?

A

Rhesus incompatibility, ABO incompatibility, Spherocytosis, congenital infection, g6PD deficiency

90
Q

If a neonate develops jaundice 2 days to 3 weeks of age what are the 4 most likely causes?

A

physiological, breast milk jaundice, infection or crigler najar syndrome

91
Q

If a neonate has jaundice past 3 weeks of age are you worries?

A

yeah - any of above conjugated and unconjugated causes throughout this flashcard set

92
Q

3 main side effects of phototherapy the neonate may experience?

A

inability of temperature regulation, macular rash, bronze discolouration to skin

93
Q

Why can a faint systolic murmur be heard in early life?

A

patent ductus arteriosus

94
Q

If a baby is symptomatic with patent ductus arteriosus what 3 things can you give to close the duct?

A

Prostaglandin synthetase inhibitors, indomethecin, ibuprofen

95
Q

What can be given to prevent apnoea?

A

Caffeine

96
Q

Established neonate on enteral feeds 1 week later stops tolerating feeds, aspirating large volumes and distended abdomen, what is initial diagnosis?

A

necrotizing enterocolitis

97
Q

What long terms complications of prematurity can arise?

A

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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