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paeds > newborn/ premie > Flashcards

newborn/ premie Flashcards

1
Q

What does APGAR look at?

A 
heart rate
resp effort
muscle tone (activity)
reflex irritability (grunting)
colour (appearance)
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2
Q

APGAR scoring?

A

HR: 2 if >100. 1 if <100. 0 if absent
Resp effort: 2 regular, strong cry. 1 gasping/ irregular. 0 absent
Muscle tone 2 well flexed, active. 1 some flexion, slightly hypotonic. 0 flaccid
reflex irritability 2 cry, cough. 1 grimace. 0 none
Appearance 2 pink all over. 1 pink w blue extremities 0 blue/ pale

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3
Q

Neonatal hypoglycaemia Mx

A

Bolus 10% dextrose

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4
Q

if mother received opioid analgesia, infant gets this

A

naloxone

to prevent resp depression

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5
Q

Newborn severe lactic acidosis mx

A

sodium bicarb

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6
Q

Nitrogen washout test (Hyperoxia test)

A

used to differentiate between cardiac and resp causes of cyanosis.
e.g. infant given 100% oxygen for 10min. ABG taken before and after.
If significant improvement, likely problem w oxygenation (resp)
If pO2 still <15kPa indicates cyanotic CHD - TOF, TGA, tricuspid atresia

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7
Q

small white pearls along midline of palate

A

epstein pearls

resolve spontaneously

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8
Q

port wine stain

A

present from birth due to vascular malformation of dermal capillaries.
may be assoc w sturge weber syndrome if along distribution of trigeminal n

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9
Q

Guthrie tests for?

A 
SCA
CF
Congenital hypothyroidism
PKU
MCADD
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10
Q

Hearing screening

A

evoked otoacoustic emission to test cochlear function

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11
Q

If abnormal hearing screening?

A

automated auditory brainstem response (AABR) done

And if abnormal -> refer to paed audiologist

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12
Q

Hypoxic ischaemic encephalopathy causes

A

significant hypoxic event immediately before/ during labour or delivery

  • placental abruption, ruptured uterus, excessive uterine contractions
  • cord compression (inc shoulder dystocia), cord prolapse
  • preeclampsia w IUGR
  • compromised fetus (IUGR, anaemia)

HIE may occur postnatally or be caused by neonatal condition e.g. kernicterus, inborn error of metabolism

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13
Q

Hypoxic ischaemic encephalopathy presentation

A

severe- comatose, severly hypotonic, needs assisted ventilation, prolonged seizures
mod- lethargic, markedly abnormal tone, requires tube feeding, seizures
mild- irritable, mild hypotonia, poor sucking

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14
Q

Hypoxic ischaemic encephalopathy MX

A

Resp support
aEEG to detect seizures / early encephalopathy
treat seizures w anticonvulsants
monitoring and treatment of hypoglycaemia and electrolyte imbalance
mild hypothermia by wrapping infant in cooling blanket reduces brain damage due to secondary neuronal death from reperfusion

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15
Q

Conditions premies are at higher risk of

A

Respiratory distress syndrome (surfactant deficiency)
Patent ductus arteriosus
Necrotizing enterocolitis
Intraventricular haemorrhage

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16
Q

RDS surfactant deficiency IX

A

CXR- ground glass appearance with air bronchograms

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17
Q

RDS antenatal prevention

A

Steroids.

IM betamethasone 12mg x2 24 hrs apart

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18
Q

RDS management

A 
surfactant therapy 
Oxygen therapy (optiflow, CPAP, assisted ventilation)
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19
Q

Intraventricular haemorrhage complications + Mx

A

may impair drainage and reabsorption of CSF -> hydrocephalus
Mx; VP shunt
initial symptomatic relief by CSF removal using LP or tap

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20
Q

necrotizing enterocolitis what is it?

A

inflammation of the intestine -> necrosis -> perforation

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21
Q

risk factors of necrotizing enterocolitis

A

preterm infant

formula fed

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22
Q

necrotizing enterocolitis tx

A

stop oral feeding, give broad spectrum abx
parenteral nutrition to rest bowel
surgery if bowel perforated

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23
Q

Necrotizing enterocolitis IX

A

Abdo Xray - distended loops of bowel and thickening of bowel wall w intramural gas
If perforated - can be detected on abdo xray / clinically

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24
Q

commonest cause of resp distress in term infants

A

transient tachypnoea of newborn

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25
Q

What is transient tachypnoea of newborn?

Risk factors

A

Caused by delay of resorption of lung fluid

RFs:
elective C-section
maternal diabetes
earlier gestational age

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26
Q

TTN Ix

A

Xray - fluid in horizontal fissure
Diagnosis of exclusion
- given ambient O2 if required

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27
Q

Meconium aspiration Mx

A

suction nose, mouth and throat
intubation to suck meconium for lungs
artificial ventilation may be required

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28
Q

Cyanosis soon after birth due to right to left shunting

Assoc w meconium aspiration, birth asphyxia, RDS

A

Persistent pulmonary HTN of newborn

29
Q

Early onset <48 h neonatal infection pathogens

A

GBS
E coli
Listeria

30
Q

Late onset infection >48h from the envt pathogen

A

CNS (staph epidermis)

most common

31
Q

Conjunctivitis within first 48h of life.

purulent discharge and eyelid swelling. gram - diplococcus

A

neisseria gonorrhoea

32
Q

conjunctivitis at 1-2wks old
purulent discharge, eyelid swelling, or shortly after birth.
Intracellular organism

A

Chlamydia trachomatis

33
Q

Gonoccocal conjunctivitis tx

A

IV ceftriaxone
clean eye frequently
mother and partner should be checked and treated

34
Q

Chlamydia conjunctivitis tx

A

Oral erythromycin for 2 wks
tetracycline eye drops
Clean eye frequently
Mother and partner should be tested and treated.

35
Q

Neonatal conjunctivitis tx

A

cleaning w saline or water.
usually resolves spontaneously.
if due to staph or strep –> topical abx eye ointment e.g. neomycin

36
Q

tracheo-oesophageal fistula assoc w pregnancy sign?

A

polyhydramnios

37
Q

tracheo-oesophageal fistula presentation

A

persistent salivation and drooling from mouth after birth
choking and coughing after feed
cyanotic episodes
-> lung aspiration of saliva/ milk or acid secretions from stomach

38
Q

VACTERL assoc w TOF

A

Verterbral, anorectal, cardiac, tracheo-oesophageal, renal and radial limb anomalies

39
Q

TOF mx

A

Surgery

40
Q

Small bowel obstruction in newborn DDx

A

presents w persistent bile-stained vomiting
or recognised on antenatal USS
meconium may be passed but subsequently delayed or absent
abdo distension

DDx
duodenal atresia/ stenosis
jejunal/ ileum stenosis
malrotation w volvulus
meconium ileus
meconium plug - thick plug causes lower intestinal obstruction
41
Q

Bowel Obstruction Ix

A

Clinical features of abdo distension, bile stained vomiting

Abdo Xray

42
Q

large bowel obstruction DDx

A 
hirschsprung's 
rectal atresia (imperforate anus)
43
Q

Newborn septic screen

A 
FBC- WCC, U&amp;Es
Blood culture
Chest XRay
LP
Urine dip + MCS
44
Q

neonatal hypoglycemia risk factors

A

<37 wks gestation

babies < 2.5kg

IUGR

maternal GDM

Mom on BBs for preeclampsia

45
Q

Neonatal hypoglycaemia Mx

A

ABC
Blood sugar
IV/ oral glucose

46
Q

neonatal jaundice in first 24h of life?

A

Rhesus haemolytic disease
ABO incompatibility
G6PD deficiency
Hereditary spherocytosis

47
Q

neonatal jaundice prolonged (>2 wks) causes?

A 
biliary atresia - raised conj br
hypothyroidism
galactosaemia
Breast milk jaundice
congenital infections (e.g. CMV, toxoplasmosis)
48
Q

Mx of Necrotizing enterocolitis

A

NBM to rest the bowel
NG tube to decompress bowel.
IV fluids, TPN and IV Abx for 10-14 days - ampicillin/ gentamicin or cefotaxime + metronidazole/ clindamycin.

surgery if deteriorating or perforated/ necrotic bowel suspected.

49
Q

ophthalmia neonatorum (neonatal conjunctival infection) - complications

A

if not promptly managed, may lead to permanent visual impairment.

50
Q

neonatal conjunctival infection ix?

A

FBC, WCC, CRP, U+Es, Blood cultures.
swabs of the eyes for MCS.
evaluate neonate for any disseminated infection.

51
Q

common serum results in Kawasaki’s?

A

raised WCC, CRP and ESR. in the second week of illness, raised Pl

52
Q

diaphragmatic hernia mx?

A

intubate baby early to prevent swallowing of air, which can cause expansion of the bowel within chest and further resp compromise.
NG tube passed and suction applied to prevent distension of the intrathoracic bowel.
After stabilisation, hernia repaired surgically.

53
Q

main complication of diaphragmatic hernia

A

pulmonary hypoplasia

and pulmonary HTN

54
Q

ix of oesophageal atresia

A

wide calibre feeding tube passed and check Xray to see if it reaches the stomach

55
Q

presentation of oesophageal atresia + tracheooesophageal fistula

A

persistent salivation and drooling from the mouth after birth. Infant will cough and choke when fed, and have cyanotic episodes.
50% will have other congenital malformations (VACTERL)

56
Q

mx of Tracheooesophageal fistula

A

continuous suction passed into oesophageal pouch to reduce aspiration of saliva and secretions whilst waiting transfer to neonatal surgical unit

57
Q

mx of meconium ileus

A

gastrografin contrast medium to diagnose and dislodge

58
Q

what to avoid in diaphragmatic hernia?

A

bag and mask ventilation

- may cause swallowing of air, expansion of the bowel and further respiratory compromise

59
Q

causes of unexpected resp distress in term newborn

A 
TTTN,
pneumothorax,
congenital pneumonia/ sepsis,
lung malformations,
congenital diaphragmatic hernia,
choanal atresia/ upper airway malformations, congenital heart disease, cerebral haemorrhage, 
oesophageal atresia/ TOF
60
Q

swelling in head several hours after birth, does not cross suture lines, can take several months to resolve

A

cephalohaematoma.

A cephalohaematoma is seen as a swelling on the newborns head. It typically develops several hours after delivery and is due to bleeding between the periosteum and skull. The most common site affected is the parietal region

jaundice may develop.

61
Q

mx of haemophilia influenza meningitis in child > 1month

A

IV cefotaxime/ ceftriaxone

+ IV dexamethasone

62
Q

if neonatal meningitis mx? <3 months old

A

IV cefotaxime + amoxicillin

63
Q

if meningitis in >3 month old?

A

IV cefotaxime

64
Q

abx prophylaxis of contacts? for bacterial meningitis

A

ciprofloxacin

65
Q

prognosis of Congenital diaphragmatic hernia dependnent on which 2 factors?

A
  1. liver -> if herniated into chest, more severe and lower chance of survival.
  2. Lung to head ratio. (ratio >1.0 reflects a better outcome.
66
Q

by what age does child’s visual acuity match that of an adult?

A

2 years of age.

67
Q

what age does child fix and follow to 90 degrees

A

6 weeks

68
Q

what age does child fix and follow to 180 degrees

A

3 months

69
Q

mx of idiopathic constipation if movicol paediatric plain does not lead to disimpaction after 2 wks?

A

add stimulant laxative e.g. senna

paeds (12 decks)

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