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SA1 - Child Health > NICU > Flashcards

NICU Flashcards

1
Q

What is a normal birth weight?

A

2.1 - 4.1 kg

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2
Q

What is a small for dates birth?

A

Newborns with weights below the 10th centile

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3
Q

What is Intrauterine growth restriction (IUGR).

What physical features does this cause?

A

Babies who fail to reach their genetically predetermined weight.

Causes an ‘old lady like appearance’ and hypoglycaemia

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4
Q

What is HIE?

What are the signs?

What is the pathophysiology?

A

Hypoxic-ischaemic-encepholopathy - Compromised gas exchange causing cardiopulmonary depression

Signs - Hypercapnia and metabolic acidosis

Tends to occur after a significant hypoxic event immdiatly before or during labour eg placental abruption, prolonged contractins, interruption of umbilical blood flor, cord compression from shoulder dystcoia, IUGR, maternal hypo/hypertension

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5
Q

Why do you do induced hypothermia in HIE?

What is the other management?

What is the prognosis?

A

Because as well as damage from initial hypoxic injury you also get repurfusion injury. Do within 6 hours of birth

Management:

  • Respiratory supoort
  • ECG monitoirng
  • Fluid restriction due to transient renal impairment
  • Monitor electrolytes

Prognosis:

Complete recovery if mild but severe can cause CP

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6
Q

What happens as a result of too much oxygen after birth.

How do you avoid this?

A

Retinopathy of prematurity

IF below 32 weeeks keep sats from 91-96%

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7
Q

What does maternal drug use cause?

How is it monitored?

A

Prematurity, growh restoriction and signs of withdrawal in the infant:

  • Jitterness
  • Sneezing
  • Vomiting
  • Yawning
  • Weight loss
  • Diarrhoea

Monitor with modified finnegan score

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8
Q
  1. What is Respiratory Distress Syndrome? Who gets it?
  2. What are the clinical signs?
  3. What are the Xray signs?
  4. What is the treatment?
A

1) Lack of surfactant in preterm babies causing low lung surface tension and respiratory distress. It is common in infants prior to 28 weeks and worse in boys.

2)

  • Tachpnoea >60
  • Signs of resp distress (grunting, head bobbbing, nasal flaring, accessory muscles
  • Cyanosis

3) Ground glass and air bronchogram
4) Antenatol glucocorticoids

Post natal surfactant into lungs via ET tube

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9
Q

What are some causes of neonatal jaundice?

What can it lead to?

What is the treatment?

A

Causes:

  • Haemolytic anaemia (rhesus disease or ABO imcompatibility)
  • Infection
  • Metabolic disease
  • Physiological jaundice
  • Dehydration

Outcome - It can cause kernicterus and deposits in the basal ganglia causing CP

Treatment - All babies are checked in the first 72 hours and treatment is phototherapy

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10
Q
  1. What is necrotising enterocolitis?
  2. What are the xray signs?
  3. What is the treatment?
  4. Long term sequelae
A
  1. It commonly affects preterm infancts and is associaed with bacterial invasion of iscahemic bowel wall. It is INFLAMMATION. It is more common in bottle fed infants and can lead to shock
  2. Distended bowel loops with thumb printing (oedema) and thickening of bowel wall
  3. NBM/TPN and broad spectrm antibiotics
  4. Malabsorption and strictures, particularly if surgery is needed
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11
Q
  1. What is meconium aspiration and what does it lead to?
  2. Long term effects/side effects
  3. Treatment
A
  1. Meconium in the lungs causing obstruction and peritonitis.
  2. Pneumomediastinum, pneumothorax, persistant pulmonary hypertension of the newborn causing R-L shunt and asphyxia and oligamia (reduced circulating blood volume)
  3. Mechanical ventilation and vasodilators
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12
Q
  1. What is a PDA?
  2. What are the symptoms?
  3. What are the signs?
  4. What is the murmur?
  5. what is the management?
A
  1. Ductus arteriosus remains open after birth - common in preterm infants
  2. Tiredness, weight loss, poor feeding
  3. Hepatomagaly, signs of HF
  4. Bounding pulse, wide pulse pressure. Murmur ULSE
  5. Ibruprofen to close it. Surgical is definitive
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13
Q

What is a Ventricular Septal Defect?

A
  • Holes in the ventricles and account for 30% of all congenital heart defects
  • The are a cyanotic as blood still gets to the lungs.
  • The louder the murmur the smaller the shunt as more turbulence
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14
Q
  1. What is a Small Ventricular Septal Defect (VSD) ?
  2. What are the symptoms?
  3. What are the signs?
  4. What is the murmur?
  5. what is the management?
A
  1. Small is 3mm or less
  2. Small are asymptomatic
  3. None
  4. Pansystolic at LLSE
  5. Closes spontaneously
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15
Q
  1. What is a Large VSD ?
  2. What are the symptoms?
  3. What are the signs?
  4. What is the murmur?
  5. what is the management?
A
  1. Over 3mm
  2. FTT, breathlessness, repeated chest infections
  3. Tachypnoea, tachycardia, active precordium.
  4. Soft pansystolic mumur
  5. Diuretics and surgery ay 6 months to prevent permanent pulmonary HTN and lung damage
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16
Q

What is an Atrial Septal Defect (ASD)?

A

A L-R acyanotic shunt of which there are two types:

Secundum (80%) - Centre of atrium involving foramen ovale

Partial/Primum (20%) - Involves AV valves

17
Q
  1. What is a ASD ?
  2. What are the symptoms?
  3. What are the signs?
  4. What is the murmur?
  5. what is the management?
A
  1. Hole in atrium (secundum or primum)
  2. Often none - Sometimes chest infection or wheeze
  3. None
  4. ESM at pulmonary valve due to increased flow across it. Fixed, Split S2
  • Treat if right ventricle dilatiation.Catheter and occlusion device for secondary -
  • Surgical correction at 3-5 years for primary
18
Q

What is tetralogy of fallot?

When are they diagnosed?

A

R-L cyanotic defect as lung flow reduces therefore CYANOSIS IS MOST COMMON SYMPTOM

There are four cardinal anatomical features:

  1. Large VSD
  2. Overriding aorta
  3. Pulmonary stenosis causing Right ventricular outflow obstruction
  4. RVH as result of above

They tend to be diagnoosed antenatally following the finding of a murmur in first 2 months of life

19
Q

Tetralogy of fallot:

  1. Signs
  2. Investigations
  3. Management
A
  1. Loud ESM at pulmonary area due to stenosis and RVH
  2. Small heart on CXR, boot shaped heart due to RVH, Pulmonary bay where PA should be
  3. Surgery at 6months to close VSD but hypercyanotic spells are self limiting and followed by sleep.

May beed B blocker, morphine and adrenaline (increase peripheral vascular resistance)

20
Q
  1. What transposition of the great arteries?
  2. What are the symptoms?
  3. What are the signs?
  4. What is the murmur?
  5. what is the management?
A
  1. PA and aorta have swopped causing cyanosis as deoxygenated blood returns to body
  2. Neonatal cyanosis
  3. Shown on echo and egg on a string sign
  4. Need to maintain ductus arteriosus so give prostanglandins to keep it open. Also balloon for foramen ovale.

Surgery eventually

21
Q

What is Eisenmenger syndrome?

A
  • L-R shunt that isnt fixed cause pulmonary hypertension
  • Shunt spontanesly resolves around 15 so child becomes blue.
  • Treat like you would treat PH
22
Q

Summary of neonatal heart defects

23
Q
  1. What antigens are the common causes of haemolytic disease of the newborn?
  2. What is the management
  3. How is it detected?
A

1) Rh

Kell

Antibodies made by the mother and cross placenta causing severe anaemia (jaundice in the newborn)

2) Management - Anti Kell or Anti D, Intraperitoneal blood transfusion, serial dopplers to monitor anaemia and blood flow and deliver early
3) detection - Indirect Coombs - Invitro looks for antibodies

24
Q

What is gastroschisis?

A

Bowel outside the body - use cling film to keep heat in

25
Q

What is hydrops fetalis

26
Q

What is hydrops fetalis?

What can it cause?

How is it monitored?

A
  1. Oedema in at least two fetal comparments usuall caused by anaemia meaning the heart needs to pump more than usual.
  2. Causes spontaneous abortion
  3. Monitored by serial dopplers and treatment depends on the cause
27
Q
  1. What is the Red Reflex?
  2. What could an abnormal red reflex indicate?
  3. Who has weaker red reflexes?
A
  1. Each pupil should show a reddish tinged when seen through the opthalmoscope
  2. abnormal - Cataract of retinoblastoma
  3. Asian or African children
28
Q

What are the 5 main primitive reflexes?

A

Moro - Sudden extension of neck causes symmetrical flexion and then extension of amrs

Grasp - Flexion of fingers when something placed in them

Root - Head turns to stimulus when touched near mouth

Stepping - Steps when held up

Asymmetrical tonic neck reflex (ATNR) - Laying supine baby extends arm to side neck is turned and flexes opposite

29
Q

What could persistant primitive reflexes mean?

Would could a lack of reflex mean?

What could a unilateral primitive reflex mean?

A

CP

Neurological damage

Hemiplegia, joint damage, nerve damage

30
Q

What type of nystagmus is normal in neonates?

A

Horizontal, not vertical

SA1 - Child Health (11 decks)

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