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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
What causes foetal heart shunts to close?
Increased oxygen saturation
26
How should a blue baby be investigated?
``` 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 ```
27
What are the 5 Ts of congenital heart problems that cause blue baby?
``` 1 - Truncus arteriosus 2 - TGA 3 - Tricuspid atresia 4 - ToF 5 - TAPVD ```
28
What should be done for a baby with hypoglycaemia?
First line increase feed Second line start iv 10% glucose Increase fluids Glucagon IM if IV doesn't work
29
What are risk factors for hypoglycaemia at birth?
Diabetic mother Macrosomia Twin-twin transfusion
30
What is done for babies with risk factors for hypoglycaemia?
Regular glucose checks
31
How is hypothermia managed?
Warm up Sepsis screen Consider thyroid function Monitor blood glucose
32
What is birth asphyxia?
Lack of oxygen at birth
33
What can cause birth asphyxia?
``` Placental abruption Long difficult delivery Umbilical cord prolapse Infection Neonatal airway problem Neonatal anaemia ie rhesus disorder ```
34
What is 1st stage of birth asphyxia?
Within minutes without oxygen - cell damage
35
What is 2nd stage birth asphyxia?
Reperfusion injury Can last days or weeks Toxins released from damaged cells
36
What are features of moderate or severe hypoxic ischaemic encephalopathy?
Abnormal movements | Seizures
37
How is hypoxic ischaemic encephalopathy managed?
``` Therapeutic hypothermia - 33-34 for 72 hours Systemic support Treat seizures EEG for clinically invisible seizures Fluid restriction for cerebral oedema ```
38
What are indications for surgery?
``` Oesophageal atresia/fistula Duodenal atresia and other GI atresias Failure to pass stool Abdominal wall defects Diaphragmatic hernia ```
39
What are causes of failure to pass stool?
Constipation Large bowel atresia Imperforate anus - stool not confirmatory - may be fistula Hirschsrpungs disease Meconium ileus - CF until proven otherwise
40
What is Hirchsprungs disease?
Lack of nerve cells in bowel causes loss of motility
41
Are babies with exomphthalos likely to have other congenital problems?
Yes
42
Why is there pulmonary hypoplasia with diaphragmatic hernia?
Abdominal organs take up chest cavity which prevents lungs fully developing due to lack of space
43
What is neonatal abstinence syndrome?
Baby has withdrawal from addictive substances mothers take
44
What are common causes of NAS?
Opioids Benzodiazepines Cocaine Amphetamines
45
How is NAS Diagnosed?
Finnegan scores | Urine toxicology - detect substances
46
How is NAS treated?
Comfort measures | Give morphine for opioids or phenobarbitone for others
47
What is plethoric skin?
Redness
48
How long should low O2 sats typically last after birth?
Around 10 minutes
49
What is kernicterus?
Brain damage from high levels of bilrubin
50
What are causes of jaundice in the first 24 hours?
Haemolytic G6PD - red cells breakdown under stress Congenital TORCH infections
51
What are causes of jaundice from the second day to week 3?
``` Physiological jaundice Breast milk jaundice Sepsis Polycythaemia Cephalhaematoma Haemolytic disorders ```
52
What are causes of jaundice after the 3rd week?
Breast milk Hypothyroidism Pyloric stenosis Cholestasis
53
How is jaundice treated?
``` Treat underlying cause Hydrate Phototherapy Exchange transfusion Immunoglobulin ```
54
At what level of bilirubin does a baby need phototherapy?
Around 350
55
What are features of erythema toxicum?
``` Maculo-papular rash 30-70% of normal term neonates Very rare in preterm Rash fades by end of week 1 No treatment required ```
56
What are features of Mongolian spots?
``` 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
What are features of neavus simplex/stork marks?
Light colour capillary dilation Commonly at back of neck May be along midline of face Gradually fades within first 2 years
58
What is naevus flammeus/port wine stain?
Presents at birth, flat or slightly raised Caused by dilated mature capillaries in superficial dermis Do not regress
59
What is naevus flammeus associated with?
Sturge Weber | Klippel Trenaunay
60
What is a capillary haemangioma/strawberry naevus?
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
What are three features of the energy triangle?
Pink Warmth Sweet
62
What is the purpose of the energy triangle?
Lack of any aspect means other aspects should be monitored
63
Who is at risk of hypoglycaemia?
Limited supply - premature babies, perinatal stress Hyperinsulinism - infants of diabetic mothers Increased glucose use - Hypothermia, sepsis
64
What are symptoms of hypoglycaemia?
``` Jitteriness - most common Temp instability Lethargy Floppy Apnoea Poor suck/feeding Vomiting High pitched or weak cry Seizures Asymptomatic ```
65
How can babies lose heat?
Evaporation - born wet Conduction - placed on cold surface Convection - cold room Radiation - Cold things near baby
66
How is cold stress managed?
Dry quickly, remove wet linens and use warm towels and blankets Provide radiant warmer hear Use heated/humidified oxygen
67
Where are different areas of recession on breathing?
Substernal Subcostal Intercostal Supra sternal
68
What is cleft palate?
Failure of maxillary and medial nasal processes to merge
69
Why is cleft palate an issue?
Feeding issues - needs special bottles and teats Airway problems Associated anomalies - need hearing screen, ECHO, and consider trisomy
70
What reflex is checked in the eyes?
Red reflex
71
What conditions can be picked up checking red reflex?
Cataracts | Retinoblastoma
72
What are spinal dimples potentially indicative of?
Serious spine abnormality | Spina bifida occulta
73
What is spina bifida?
Section of spinal cord is outside spinal canal
74
What is a cephalohaematoma?
Localised swelling over one or both sides of head
75
What are features of cephalohaematoma?
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
How re talipes treated?
Physiotherapy
77
How are fixed talipes treated?
Vigorous manipulation Casting Surgery
78
What should be done if Barlow or Ortolani test are positive?
Hip USS
79
What is the goal of DDH treatment?
Relocate head of femur to acetabulum so hip develops normally
80
How is DDH treated?
Usually just Pavlik harness | May need surgical reduction

Paediatrics (25 decks)

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