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Paediatrics > Neonatology part 2 > Flashcards

Neonatology part 2 Flashcards

1
Q

What gestation is classified as term?

A

37-42 weeks

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2
Q

What are symptoms of sepsis in neonates?

A 
Pyrexia OR hypothermia
Poor feeding
Lethargy OR irritable
Early jaundice
Tachypnoea - >60
Hypo OR hyperglycaemia
Floppy 
Asymptomatic
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3
Q

What are risk factors for sepsis in neonates?

A

Maternal pyrexia
Prolonged rupture of membranes
Maternal Group B strep carriage

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4
Q

What is a baby’s normal posture generally?

A

Flexed joints - elbows and knees

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5
Q

How is presumed sepsis managed?

A

Admit to neonatal unit
Partial septic screen - FBC, CRP, blood cultures, blood gas
CXR or Lumbar puncture
IV penicillin and gentamicin first line
2nd line IV vancomycin and gentamicin
Add metronidazole if surgical/abdominal concerns
Fluid management and treat acidosis
Monitor vital signs and support resp and CVS as required

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6
Q

What are the most common causes of neonatal sepsis?

A 
Group B strep
E.coli
Listeria
Coagulase negative staph
Haemophilus influenzae
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7
Q

What are features of group B strep sepsis?

A

Early onset - birth to 1 week
Late onset or recurrence
Symptoms may be non specific
May have no risk factors

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8
Q

What are complications of group B strep sepsis?

A

Meningitis
DIC
Pneumonia and resp collapse
Hypotension and shock

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9
Q

What are the TORCH congenital infections?

A

Toxoplasmosis
Rubella
Cytomegalovirus
Herpes

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10
Q

What are complications of congenital infections?

A 
Intrauterine growth restriction
Brain calcifications
Neurodevelopmental delay
Visual impairment
Recurrent infections
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11
Q

How are congenital infections screened for?

A

TORCH screening

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12
Q

What are common heart defects in congenital infections?

A

Cardiomegaly

Patent ductus arteriosus

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13
Q

What are causes of resp distress?

A

Sepsis
Transient tachypnoea of the newborn
Meconium aspiration

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14
Q

What are features of respiratory distress?

A

Grunting
Recession under ribs
Nasal flaring

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15
Q

What are features of transient tachypnoea of the newborn?

A 
Self limiting and common
Presents within first few hours
Grunting
Tachypnoea
Oxygen requirement
Normal gases
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16
Q

What causes TTN?

A

Delay in clearance of foetal lung fluids

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17
Q

How is TTN managed?

A

Supportive
Oxygen
CPAP

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18
Q

What is the main feature of TTN on Xray?

A

Fluid in the transverse fissure

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19
Q

What is meconium aspiration?

A

Meconium inhaled into the lungs

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20
Q

What are risk factors for meconium aspiration?

A

Post dates
Maternal diabetes
Maternal hypertension
Difficult labour

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21
Q

What are symptoms of meconium aspiration?

A 
Cyanosis
Increased work of breathing
Grunting
Apnoea
Floppiness
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22
Q

What investigations are done into meconium aspiration?

A

Blood gas
Septic screen
CXR

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23
Q

How is meconium aspiration managed?

A 
Suction below cords
Airway support
Fluids and iv antibiotics
Surfactant
Inhaled nitric oxide
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24
Q

Why is surfactant required in meconium aspiration?

A

Meconium inactivates surfactant

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25
Q

What causes foetal heart shunts to close?

A

Increased oxygen saturation

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26
Q

How should a blue baby be investigated?

A 
Exam and history
Sepsis screen
Blood gas and glucose
CXR
Pulse oximetry
ECG
ECHO
Hyperoxia test - lung pathology will improve with high oxygen levels, cardiac pathology won't - differentiate
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27
Q

What are the 5 Ts of congenital heart problems that cause blue baby?

A 
1 - Truncus arteriosus
2 - TGA
3 - Tricuspid atresia
4 - ToF
5 - TAPVD
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28
Q

What should be done for a baby with hypoglycaemia?

A

First line increase feed
Second line start iv 10% glucose
Increase fluids
Glucagon IM if IV doesn’t work

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29
Q

What are risk factors for hypoglycaemia at birth?

A

Diabetic mother
Macrosomia
Twin-twin transfusion

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30
Q

What is done for babies with risk factors for hypoglycaemia?

A

Regular glucose checks

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31
Q

How is hypothermia managed?

A

Warm up
Sepsis screen
Consider thyroid function
Monitor blood glucose

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32
Q

What is birth asphyxia?

A

Lack of oxygen at birth

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33
Q

What can cause birth asphyxia?

A 
Placental abruption
Long difficult delivery
Umbilical cord prolapse
Infection
Neonatal airway problem
Neonatal anaemia ie rhesus disorder
34
Q

What is 1st stage of birth asphyxia?

A

Within minutes without oxygen - cell damage

35
Q

What is 2nd stage birth asphyxia?

A

Reperfusion injury
Can last days or weeks
Toxins released from damaged cells

36
Q

What are features of moderate or severe hypoxic ischaemic encephalopathy?

A

Abnormal movements

Seizures

37
Q

How is hypoxic ischaemic encephalopathy managed?

A 
Therapeutic hypothermia - 33-34 for 72 hours
Systemic support
Treat seizures
EEG for clinically invisible seizures
Fluid restriction for cerebral oedema
38
Q

What are indications for surgery?

A 
Oesophageal atresia/fistula
Duodenal atresia and other GI atresias
Failure to pass stool
Abdominal wall defects
Diaphragmatic hernia
39
Q

What are causes of failure to pass stool?

A

Constipation
Large bowel atresia
Imperforate anus - stool not confirmatory - may be fistula
Hirschsrpungs disease
Meconium ileus - CF until proven otherwise

40
Q

What is Hirchsprungs disease?

A

Lack of nerve cells in bowel causes loss of motility

41
Q

Are babies with exomphthalos likely to have other congenital problems?

A

Yes

42
Q

Why is there pulmonary hypoplasia with diaphragmatic hernia?

A

Abdominal organs take up chest cavity which prevents lungs fully developing due to lack of space

43
Q

What is neonatal abstinence syndrome?

A

Baby has withdrawal from addictive substances mothers take

44
Q

What are common causes of NAS?

A

Opioids
Benzodiazepines
Cocaine
Amphetamines

45
Q

How is NAS Diagnosed?

A

Finnegan scores

Urine toxicology - detect substances

46
Q

How is NAS treated?

A

Comfort measures

Give morphine for opioids or phenobarbitone for others

47
Q

What is plethoric skin?

A

Redness

48
Q

How long should low O2 sats typically last after birth?

A

Around 10 minutes

49
Q

What is kernicterus?

A

Brain damage from high levels of bilrubin

50
Q

What are causes of jaundice in the first 24 hours?

A

Haemolytic
G6PD - red cells breakdown under stress
Congenital TORCH infections

51
Q

What are causes of jaundice from the second day to week 3?

A 
Physiological jaundice
Breast milk jaundice
Sepsis
Polycythaemia
Cephalhaematoma
Haemolytic disorders
52
Q

What are causes of jaundice after the 3rd week?

A

Breast milk
Hypothyroidism
Pyloric stenosis
Cholestasis

53
Q

How is jaundice treated?

A 
Treat underlying cause
Hydrate
Phototherapy
Exchange transfusion
Immunoglobulin
54
Q

At what level of bilirubin does a baby need phototherapy?

A

Around 350

55
Q

What are features of erythema toxicum?

A 
Maculo-papular rash
30-70% of normal term neonates
Very rare in preterm
Rash fades by end of week 1
No treatment required
56
Q

What are features of Mongolian spots?

A 
Blue-grey pigmentations
Often lower back and buttocks
Accumulation of melanocytes
Very common in races with pigmented skin
Document that baby has it because can be reported as NAI
57
Q

What are features of neavus simplex/stork marks?

A

Light colour capillary dilation
Commonly at back of neck
May be along midline of face
Gradually fades within first 2 years

58
Q

What is naevus flammeus/port wine stain?

A

Presents at birth, flat or slightly raised
Caused by dilated mature capillaries in superficial dermis
Do not regress

59
Q

What is naevus flammeus associated with?

A

Sturge Weber

Klippel Trenaunay

60
Q

What is a capillary haemangioma/strawberry naevus?

A

Cluster of dilated capillaries appearing within first month
Raised and bright red with discrete edges in any part of the body
Usually regresses after one year of age

61
Q

What are three features of the energy triangle?

A

Pink
Warmth
Sweet

62
Q

What is the purpose of the energy triangle?

A

Lack of any aspect means other aspects should be monitored

63
Q

Who is at risk of hypoglycaemia?

A

Limited supply - premature babies, perinatal stress
Hyperinsulinism - infants of diabetic mothers
Increased glucose use - Hypothermia, sepsis

64
Q

What are symptoms of hypoglycaemia?

A 
Jitteriness - most common
Temp instability
Lethargy
Floppy
Apnoea
Poor suck/feeding
Vomiting
High pitched or weak cry
Seizures
Asymptomatic
65
Q

How can babies lose heat?

A

Evaporation - born wet
Conduction - placed on cold surface
Convection - cold room
Radiation - Cold things near baby

66
Q

How is cold stress managed?

A

Dry quickly, remove wet linens and use warm towels and blankets
Provide radiant warmer hear
Use heated/humidified oxygen

67
Q

Where are different areas of recession on breathing?

A

Substernal
Subcostal
Intercostal
Supra sternal

68
Q

What is cleft palate?

A

Failure of maxillary and medial nasal processes to merge

69
Q

Why is cleft palate an issue?

A

Feeding issues - needs special bottles and teats
Airway problems
Associated anomalies - need hearing screen, ECHO, and consider trisomy

70
Q

What reflex is checked in the eyes?

A

Red reflex

71
Q

What conditions can be picked up checking red reflex?

A

Cataracts

Retinoblastoma

72
Q

What are spinal dimples potentially indicative of?

A

Serious spine abnormality

Spina bifida occulta

73
Q

What is spina bifida?

A

Section of spinal cord is outside spinal canal

74
Q

What is a cephalohaematoma?

A

Localised swelling over one or both sides of head

75
Q

What are features of cephalohaematoma?

A

Soft
Non translucent
Limited to a cranial bone - usually parietal
Haemorrhage beneath pericranium
No treatment required
May have jaundice due to increased blood breakdown
No association with intracranial bleeding

76
Q

How re talipes treated?

A

Physiotherapy

77
Q

How are fixed talipes treated?

A

Vigorous manipulation
Casting
Surgery

78
Q

What should be done if Barlow or Ortolani test are positive?

A

Hip USS

79
Q

What is the goal of DDH treatment?

A

Relocate head of femur to acetabulum so hip develops normally

80
Q

How is DDH treated?

A

Usually just Pavlik harness

May need surgical reduction

Paediatrics (25 decks)

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