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Child Health > Neonatology & infancy > Flashcards

Neonatology & infancy Flashcards

1
Q

Function of ductus venosus

A

Allows oxygenated blood in umbilical vein to by-pass the liver, carrying blood to IVC, which drains blood into right atrium.

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2
Q

Function of foramen ovale

A

Shunts oxygenated blood from right atrium into left atrium.

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3
Q

Function of ductus arteriosus

A

Connects pulmonary artery to aorta, allowing oxygenated blood to bypass the immature foetal lungs. It normally stops functioning within 1–3 days of birth. It allows blood from the deoxygenated right sided circulation before the lungs to mix with the oxygenated left sided circulation after the lungs.

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4
Q

Describe the ‘waiters tip’ appearance in Erb’s palsy

A
  • Internally rotated shoulder
  • Extended elbow
  • Flexed wrist facing backwards (pronated)
  • Lack of movement in the affected arm
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5
Q

Is conjugated neonatal jaundice always physiological or pathological?

A

Pathological

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6
Q

Define apnoea of prematurity

A

Periods where breathing stops spontaneously for more than 20 seconds, or shorter periods with oxygen desaturation or bradycardia. Very common in neonates less than 28 weeks gestation.

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7
Q

What causes apnoea of prematurity?

A

Due to immaturity of the autonomic nervous system.

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8
Q

Describe the management of apnoea of prematurity

A
  • Neonatal units attach apnoea monitors to premature babies. These make a sound when an apnoea is occurring. Tactile stimulation is used to prompt the baby to restart breathing.
  • IV caffeine can be used to prevent apnoea and bradycardia in babies with recurrent episodes.
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9
Q

Define retinopathy of prematurity

A

Visual impairment affecting preterm babies before 32 weeks gestation and low birth weight babies.

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10
Q

Describe the pathophysiology of retinopathy of prematurity

A

Abnormal development of blood vessels in the retina due to oxygen therapy in preterm babies (hypoxia normally stimulates blood vessel formation). When the hypoxic environment recurs, it causes neovascularisation and scar tissue formation, leading to retinal detachment and blindness.

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11
Q

When should screening for retinopathy of prematurity be performed?

A

In babies born before 32 weeks or under 1.5kg.

  • 30- 31 weeks gestational age in babies born before 27 weeks.
  • 4-5 weeks of age in babies born after 27 weeks.

Screening should happen at least every 2 weeks and can cease once the retinal vessels enter zone 3, usually at around 36 weeks gestation.

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12
Q

Management for retinopathy of prematurity?

A

Transpupillary laser photocoagulation (first line) to stop and reverse neovascularisation.

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13
Q

Describe the pathophysiology of respiratory distress syndrome

A

Occurs in premature neonates less than 32 weeks gestation due to inadequate surfactant production. This leads to increased surface tension within the alveoli causing lung collapse and inadequate gas exchange. This results in hypoxia, hypercapnia and respiratory distress.

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14
Q

Name the CXR finding seen in respiratory distress syndrome

A

Ground glass appearance.

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15
Q

Why are antenatal steroids given to mothers with suspected or confirmed preterm labour?

A

To increase the production of surfactant, in order to reduce the incidence and severity of RDS.

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16
Q

What is the management for respiratory distress syndrome?

A
  • Intubation and ventilation to fully assist breathing if the respiratory distress is severe.
  • Endotracheal surfactant, which is artificial surfactant delivered into the lungs via an endotracheal tube.
  • Continuous positive airway pressure (CPAP) via a nasal mask to help keep the lungs inflated whilst breathing.
  • Supplementary oxygen to maintain oxygen saturations between 91 and 95% in preterm neonates.
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17
Q

Describe the features of congenital varicella syndrome

A
  • FGR.
  • Microcephaly, hydrocephalus and learning disability.
  • Scars and significant skin changes following the dermatomes.
  • Limb hypoplasia (underdeveloped limbs).
  • Cataracts and inflammation in the eye (chorioretinitis).
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18
Q

Signs of respiratory distress syndrome or increased work of breathing

A
  • Abdominal breathing.
  • Subcostal recession.
  • Nasal flaring.
  • Grunting.
  • Head bobbing.
  • Cyanosis.
  • Tachypnoea or apnoea.
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19
Q

List some causes of intraventricular haemorrhage (IVH) in neonates

A

Prematurity makes blood vessels more fragile and is more common in babies that have had physical stress:

  • Hypoxia.
  • Respiratory distress.
  • Pneumothorax.
  • Hypertension.
  • Birth trauma.

The blood may clot and occlude CSF flow, hydrocephalus may result. IVH occur in the first 72 hours after birth.

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20
Q

What are the common congenital anomalies identified in neonates?

A
  • Congenital heart.
  • Chromosomal (trisomy 21).
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21
Q

Diagnosis of IVH?

A

Cranial US (through fontanelles).

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22
Q

Describe some symptoms of IVH

A
  • Apnoea.
  • Decreased tone.
  • Decreased reflexes.
  • Excessive sleep and lethargy.
  • Weak suck.
  • Convulsions.
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23
Q

What are the complications of IVH?

A

Hydrocephalus, cerebral palsy and developmental delay.

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24
Q

Describe meconium aspiration syndrome

A

Aspiration of meconium stained amniotic fluid either antenatally or during birth, which causes respiratory distress in the newborn.

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25
Q

Describe the CXR findings of meconium aspiration syndrome

A
  • Increased lung volumes.
  • Asymmetrical patchy pulmonary opacities.
  • Pleural effusions.
  • Pneumothorax or pneumomediastinum.
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26
Q

An ABG from a neonate is usually taken from where?

A

Umbilical artery catheter

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27
Q

Describe basic management of meconium aspiration syndrome

A
  • Infant warmer.
  • Nutritional support via IV fluids, then NG and oral feeds when permitting.
  • Oxygen therapy via a nasal cannula, CPAP, intubation or mechanical ventilation.
  • IV antibiotics.
  • Surfactant.
  • Inhaled NO if there’s pulmonary HTN present.
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28
Q

Describe the complications of meconium aspiration syndrome

A
  • Air leak leading to a pneumothorax or pneumomediastinum.
  • Persistent pulmonary hypertension of the newborn (PPHN).
  • Cerebral palsy.
  • Chronic lung disease.
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29
Q

What is PPHN?

A

Persistent pulmonary hypertension occurs due to failure of normal transition from intrauterine circulation. It is characterised by persistently elevated pulmonary vascular resistance resulting in decreased pulmonary blood flow causing respiratory distress.

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30
Q

What is biliary atresia?

A

A congenital condition where a section of the bile duct is either narrowed or absent, resulting in cholestasis.

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31
Q

What is the management for biliary atresia?

A
  • The ‘Kasai portoenterostomy’ surgery - attaching a section of the small intestine to the opening of the liver, where the bile duct normally attaches.
  • Full liver transplant.
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32
Q

Hypospadias is associated with..

A

Cryptorchidism

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33
Q

Describe the features of congenital rubella syndrome

A
  • Sensorineural deafness
  • Congenital cataracts
  • Congenital heart disease e.g. PDA
34
Q

Describe the features of congenital toxoplasmosis

A
  • Cerebral calcification
  • Chorioretinitis
  • Hydrocephalus
35
Q

Describe the features of congenital CMV

A
  • Low birth weight
  • Purpuric/petechial rash
  • Sensorineural deafness
  • Microcephaly
  • Seizures
36
Q

Describe the features of congenital varicella syndrome

A
  • Cataracts
  • Skin scarring
  • Microphthalmia
  • Limb hypoplasia
  • Microcephaly
37
Q

Ebstein’s anomaly is associated with which drug exposure in-utero?

A

Lithium

38
Q

Describe the congenital heart defect seen in Ebstein’s anomaly

A

Low insertion of the tricuspid valve resulting in a large atrium and small ventricle. Aka atrialisation of the right ventricle.

39
Q

Describe an innocent murmur (flow murmur) and it’s cause

A
  • Soft, systolic, short, symptomless, and situation dependent (particularly if the murmur gets quieter with standing or only appears when the child is unwell or feverish).
  • They’re caused by fast blood flow through various areas of the heart during systole.
40
Q

What is the average HR and RR for a child < 1 and > 12?

A

< 1

  • HR: 110-160
  • RR: 30-40

> 12

  • HR: 60-100
  • RR: 15-20
41
Q

Is hypoglycaemia in the first 24 hours of life normal in term babies?

A

Yes

42
Q

List the risk factors for neonatal hypoglycaemia

A
  • Preterm birth
  • Maternal diabetes
  • IUGR
  • Hypothermia
  • Neonatal sepsis
  • Inborn error of metabolism
  • Nesidioblastosis
  • Beckwith-Wiedemann syndrome
43
Q

Outline the features of neonatal hypoglycaemia

A
  • Jitteriness, irritable, tachypnoea, pallor.
  • Poor feeding, weak cry, drowsy, hypotonia, seizures.
  • Apnoea, hypothermia.
44
Q

Outline the management of neonatal hypoglycaemia

A
  • Asymptomatic: encourage normal feeding.
  • Symptomatic/very low glucose: IV infusion of 10% dextrose.
45
Q

Gastroschisis vs exomphalos (omphalocoele)

A

Gastrochisis:

  • Congenital defect in anterior abdominal wall where abdominal organs protrude outside abdomen with no protective membrane covering them.
  • Requires urgent correct e.g. within 4 hours of delivery.

Exomphalos (omphalocoele):

  • Abdominal contents protrude through anterior abdominal wall but are covered in an amniotic sac.
  • C-section to reduce risk of sack rupture.
  • Gradual, staged repair to prevent respiratory complications.
46
Q

Name a risk factor for meconium aspiration syndrome

A

Post-term delivery (>42 weeks)

47
Q

When should the APGAR score be assessed?

A

1 and 5 mins of age

48
Q

Early-onset neonatal sepsis is most commonly caused by which organism?

A

Group B streptococcus

49
Q

What is the most common presentation of neonatal sepsis?

A

Grunting or other signs of respiratory distress.

50
Q

What are the complications of undescended testis?

A
  • Infertility
  • Torsion
  • Testicular cancer
51
Q

Outline the management for undescended testis

A
  • Unilateral: if discovered at birth review at 3 months of age, if it persists then referral to urology.
  • Bilateral: reviewed by senior paediatrician within 24 hours.
52
Q

What can cause microcephaly?

A

Foetal alcohol syndrome

53
Q

When does chronic lung disease of prematurity occur?

A

In premature babies, typically before 28 weeks gestation.

54
Q

How is chronic lung disease of prematurity diagnosed?

A

CXR

55
Q

Once the neonate is born how is the risk of chronic lung disease of prematurity reduced?

A
  • Using CPAP rather than intubation and ventilation when possible.
  • Using caffeine to stimulate the respiratory effort.
  • Not over-oxygenating with supplementary oxygen.
56
Q

Outline the management for chronic lung disease of prematurity

A
  • Low dose oxygen to continue at home, then weaned off over the first year of life.
  • Palivizumab to reduce risk of bronchiolitis.
57
Q

What causes transient tachypnoea of the newborn?

A

Delayed resorption of fluid in the lungs. More common after caesarean sections due to fluid not be squeezed out during passes through the birth canal.

58
Q

X-ray findings for transient tachypnoea of the newborn?

A

Hyperinflation of lungs and fluid in horizontal fissure.

59
Q

Outline the management for transient tachypnoea of the newborn

A
  • Observation and supportive care.
  • Oxygen therapy may be required.
  • Usually settles within 1-2 days.
60
Q

Describe infantile colic

A

Relatively common and benign set of symptoms, typically occurring in infant < 3 months old and characterised by bouts of excessive crying and pulling-up of the legs, often worse in the evening.

61
Q

What is NOT recommended for the treatment of infantile colic?

A
  • Simeticone (e.g. Infacol)
  • Lactase (e.g. Colief) drops
62
Q

What sign would make you consider a diaphragmatic hernia?

A

Bowel sounds in respiratory exam of a neonate.

63
Q

Which drug is used to promote PDA closure?

A

Indomethacin or ibuprofen - given to the neonate in the postnatal period.

64
Q

Name two causes of pulmonary hypoplasia

A
  • Oligohydramnios
  • Congenital diaphragmatic hernia
65
Q

What complication can occur if a foetus is homozygous for alpha-thalassaemia?

A

Hydrops fetalis

66
Q

Outline risk factors for cleft palate

A
  • In pregnancy: smoking, benzodiazepine use, anti-epileptic use, rubella infection.
  • Syndromic disorders: trisomy 18, 13 & 15.
67
Q

What is the newborn hearing screening test called?

A

Otoacoustic emission testing

68
Q

What test is performed upon abnormal otoacoustic emmsion testing?

A

Auditory brainstem response

69
Q

Which hearing test is performed on school-age children upon entry to school?

A

Pure tone audiometry

70
Q

What problems can a cleft palate lead to?

A
  • Difficulty with feeding, swallowing and speech.
  • Prone to hearing problems, ear infections and glue ear.
71
Q

Management of cleft lip/palate

A
  • MDT involvement
  • Special shaped bottles and teats
  • Surgical correction - cleft lip at 3 months and cleft palate at 6-12 months
72
Q

How does ankyloglossia usually present?

A

With difficulty feeding

73
Q

What is the management of ankyloglossia

A

Frenotomy

74
Q

What is a cystic hygroma?

A

Congenital abnormality resulting in a cyst filled with lymphatic fluid, located in the posterior triangle of the neck on the left side.

75
Q

At what stage in pregnancy can chickenpox in the mother cause congenital varicella syndrome?

A

Before 28 weeks gestation

76
Q

Management of umbilical hernia

A
  • Usually self-resolve, but if large or symptomatic perform elective repair at 2-3 years of age.
  • If small and asymptomatic peform elective repair at 4-5 years of age.
77
Q

Jaundice in the first 24 hours of life if always pathological or physiological?

A

Pathological

78
Q

List the risk factors for respiratory distress syndrome

A
  • Male
  • Diabetic mother (insulin inhibits surfactant production and maturation of foetal lungs)
  • C-section
  • Second born of premature twins
79
Q

A 1-day old child is born by emergency cesarean section for foetal distress. On examination, he has decreased air entry on the left side of his chest and a displaced apex beat. Abdominal examination demonstrates a scaphoid abdomen but is otherwise unremarkable.

A

Congenital diaphragmatic hernia

80
Q

Management of inguinal hernias

A
  • Presenting in first few months of life: highest risk for strangulation so hernia should be repaired urgently.
  • Children > 1: lower risk so elective surgery.
81
Q

What is the treatment for IVH?

A
  • Largely supportive.
  • Hydrocephalus and rising ICP is an indication for shunting.

Child Health (9 decks)

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