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Phase 3a medicine > Paediatric - Neonatal > Flashcards

Paediatric - Neonatal Flashcards

1
Q

Which medication should be commenced urgently in the newborn with transposition of the great arteries

A

Prostglandin E1

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2
Q

Name some features of neonatal hypoglycaemia

A

may be asymptomatic

autonomic (hypoglycaemia → changes in neural sympathetic discharge)

  • ‘jitteriness’
  • irritable
  • tachypnoea
  • pallor

neuroglycopenic

  • poor feeding/sucking
  • weak cry
  • drowsy
  • hypotonia
  • seizures

other features may include

  • apnoea
  • hypothermia
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3
Q

What is the management of symptomatic vs asymptomatic neonatal hypoglycaemia?

A

asymptomatic

  • encourage normal feeding (breast or bottle)
  • monitor blood glucose

symptomatic or very low blood glucose

  • admit to the neonatal unit
  • intravenous infusion of 10% dextrose
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4
Q

Respiratory distress syndrome commonly occurs for neonates born under what gestation?

A

Under 32 weeks

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5
Q

Respiratory distress syndrome has what characteristic X-ray finding?

A

Ground-glass appearance

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6
Q

Respiratory distress syndrome is caused by a deficiency of what in the lungs?

A

Surfactant

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7
Q

What is Atelectasis?

A

Lung collapse

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8
Q

What is given to mothers with suspected or confirmed preterm labour due to risk of respiratory distress syndrome?

A

Antenatal steroids (Dexamethasone) increase the production of surfactant and reduce the incidence and severity of respiratory distress syndrome in the baby.

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9
Q

Steps of Neonatal Resuscitation

UK Resuscitation Council

A
  1. ) Warm The Baby
    - Get the baby dry as quickly as possible. Vigorous drying also helps stimulate breathing.
    - Keep the baby warm with warm delivery rooms and management under a heat lamp
    - Babies under 28 weeks are placed in a plastic bag while still wet and managed under a heat lamp
  2. ) Calculate the APGAR Score
    - This is done at 1, 5 and 10 minutes whilst resuscitation continues
    - This is used as an indicator of the progress over the first minutes after birth
    - It helps guide neonatal resuscitation efforts
  3. ) Stimulate Breathing
    - Stimulate the baby to prompt breathing, for example by drying vigorously with a towel
    - Place the baby’s head in a neutral position to keep airway open. A towel under the shoulders can help keep it neutral.
    - If gasping or unable to breath, check for airway obstruction (i.e. meconium) and consider aspiration under direct visualisation
  4. ) Inflation Breaths
    - Inflation breaths are given when the neonate is gasping or not breathing despite adequate initial simulation.
    - (2x5)Two cycles of five inflation breaths (lasting 3 seconds each) can be given to stimulate breathing and heart rate
    - If there is no response and the heart rate is low, 30 seconds of ventilation breaths can be used
    - When performing inflation breaths, air should be used in term or near term babies, and a mix of air and oxygen should be used in pre-term babies. Oxygen saturations can be monitored throughout resuscitation if there are concerns about the breathing. Aim for a gradual rise in oxygen saturations, not exceeding 95%.
  5. ) Chest Compressions
    - Start chest compressions if heart rate remains below 60 bpm despite resuscitation and inflation breaths (see protocol)
    - (3:1)Chest compressions are performed at a 3:1 ratio with ventilation breaths

(Severe Situations - Prolonged hypoxia increases the risk of hypoxic-ischaemic encephalopathy (HIE). In severe situations, IV drugs and intubation should be considered. Babies near or at term that have possible HIE may benefit from therapeutic hypothermia with active cooling)

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10
Q

Resuscitation council UK states that uncompromised neonates should have a delay of how long for clamping umbilical cord after birth?

A

At least one minute

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11
Q

Name a short term and a long term complication of Respiratory Distress Syndrome

A

Short term complications:

  • Pneumothorax
  • Infection
  • Apnoea
  • Intraventricular haemorrhage
  • Pulmonary haemorrhage
  • Necrotising enterocolitis

Long term complications:

  • Chronic lung disease of prematurity
  • Retinopathy of prematurity occurs more often and more severely in neonates with RDS
  • Neurological, hearing and visual impairment
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12
Q

Bronchopulmonary Dysplasia = oxygen dependence at what gestation of postmenstrual age? (gestational age plus chronological age)

A

BPD is oxygen dependence at 36 weeks of postmenstrual age (gestational age plus chronological age)

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13
Q

Name a sign of meconium aspiration in the neonate

A
  • Obvious presence of meconium or dark green staining of the amniotic fluid.
  • Green or blue staining of the skin at birth.
  • Baby appears limp, with a low Apgar score.
  • Breathing is rapid, laboured, or absent.
  • Signs of postmaturity (eg, peeling skin) are present.
  • Fetal monitor may show bradycardia.
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14
Q

Therapeutic intervention of Meconium Aspiration Syndrome

A
  • Airway suctioning
  • Oxygen delivery
  • Ventilatory support
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15
Q

What can Hypoxic ischaemic encephalopathy (HIE) cause if there is permanent damage to the brain?

A

Cerebral Palsy

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16
Q

Name a cause of Hypoxic ischaemic encephalopathy (HIE)

A
  • Maternal shock
  • Intrapartum haemorrhage
  • Prolapsed cord, causing compression of the cord during birth
  • Nuchal cord, where the cord is wrapped around the neck of the baby
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17
Q

What is a treatment option to help protect the brain from hypoxic injury if babies near or at term are considered to have HIE?

A

Therapeutic cooling

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18
Q

What does TORCH infection stand for?

A

Toxoplasmosis, Other (syphilis, varicella-zoster, parvovirus B19, listeria), Rubella, Cytomegalovirus, Herpes

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19
Q

Name a cause of neonatal jaundice due to increased production of bilirubin and a cause due to decreased clearance

A

Increased production of bilirubin:

  • Haemolytic disease of the newborn
  • ABO incompatibility
  • Haemorrhage
  • Intraventricular haemorrhage
  • Cephalo-haematoma
  • Polycythaemia
  • Sepsis and disseminated intravascular coagulation
  • G6PD deficiency

Decreased clearance of bilirubin:

  • Prematurity
  • Breast milk jaundice
  • Neonatal cholestasis
  • Extrahepatic biliary atresia
  • Endocrine disorders (hypothyroid and hypopituitary)
  • Gilbert syndrome

TIP: Jaundice in the first 24 hours of life is pathological. This needs urgent investigations and management. Neonatal sepsis is a common cause.

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20
Q

What is Kernicterus?

A

Kernicterus is brain damage due to high bilirubin levels

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21
Q

What is used to treat neonatal jaundice?

A

Phototherapy / Exchange transfusion

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22
Q

Name a risk factor for Necrotising enterocolitis

A
  • Very low birth weight or very premature
  • Formula feeds (it is less common in babies fed by breast milk feeds)
  • Respiratory distress and assisted ventilation
  • Sepsis
  • Patent ductus arteriosus and other congenital heart disease
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23
Q

Name a feature of necrotising enterocolitis

A
  • Intolerance to feeds
  • Vomiting, particularly with green bile
  • Generally unwell
  • Distended, tender abdomen
  • Absent bowel sounds
  • Blood in stools

When perforation occurs there will be peritonitis and shock and the neonate will be severely unwell.

24
Q

What is the investigation of choice for diagnosis of necrotising enterocolitis?

A

Abdominal X-ray

25
Q

What is Gastroschisis?

A

Gastroschisis occurs during early pregnancy when a baby’s abdominal (tummy) wall does not fully close. This leaves a hole in their abdominal wall (usually to the right side of their tummy button), which allows their bowel (intestines) and other organs to grow outside of their abdomen instead of inside

26
Q

Oesophageal atresia is usually associated with what other condition?

A

Tracheo-oesophageal fistula / Polyhydramniosis during pregnancy

27
Q

How is bowel atresia treated?

A

sur­gically, after correction of fluid and electrolyte deple­tion

28
Q

Features of Fetal Alcohol Syndrome

A
  • Microcephaly (small head)
  • Thin upper lip
  • Smooth flat philtrum (the groove between the nose and upper lip)
  • Short palpebral fissure (short horizontal distance from one side of the eye and the other)
  • Learning disability
  • Behavioural difficulties
  • Hearing and vision problems
  • Cerebral palsy
29
Q

Features of congenital rubella syndrome (4 of em)

A
  • Congenital cataracts
  • Congenital heart disease (PDA and pulmonary stenosis)
  • Learning disability
  • Hearing loss
30
Q

Features of congenital varicella syndrome

A
  • Fetal growth restriction
  • Microcephaly, hydrocephalus and learning disability
  • Scars and significant skin changes following the dermatomes
  • Limb hypoplasia (underdeveloped limbs)
  • Cataracts and inflammation in the eye (chorioretinitis)
31
Q

Features of congenital CMV

A
  • Fetal growth restriction
  • Microcephaly
  • Hearing loss
  • Vision loss
  • Learning disability
  • Seizures
32
Q

Classic triad of congenital toxoplasmosis

A
  • Intracranial calcification
  • Hydrocephalus
  • Chorioretinitis
33
Q

Group B Streptococcus is found where in 20-40% of women?

A

Vagina + rectum

34
Q

Signs of GBS infection in neonate

A

grunting, noisy breathing, moaning, seeming to be working hard to breathe when you look at their chest or tummy, or not breathing at all
• be very sleepy and/or unresponsive
• be crying inconsolably
• be unusually floppy
• not feeding well or not keeping milk down
• have a high or low temperature and/or their skin feels too hot or cold
• have changes in their skin colour (including blotchy skin)
• have an abnormally fast or slow heart rate or breathing rate
• have low blood pressure*
• have low blood sugar.*

35
Q

How is Neonatal Listeriosis diagnosed and treated?

A

Diagnosis

  • Culture or polymerase chain reaction (PCR) testing of blood, cervix, and amniotic fluid (if available)
  • Culture or PCR of blood, cerebrospinal fluid (CSF), gastric aspirate, meconium, and infected tissues of sick neonate

Treatment
- Antibiotics (Ampicillin + Aminoglycoside)

36
Q

What is the standard treatment of Herpes Simplex Encephalitis?

A

Newborns + children standard treatment = 21 days Aciclovir

(rather than the adult 14 day course with repeated LP at 7 day intervals after this to ensure clearance of virus before stopping the Aciclovir)

37
Q

Name a risk factor for cleft lip and palate defect

A
  • genetics a child inherits from their parents (but most cases are a one-off)
  • smoking during pregnancy or drinking alcohol during pregnancy
  • obesity during pregnancy
  • a lack of folic acid during pregnancy
  • taking certain medicines in early pregnancy (some anti-seizure medications and steroid tablets)
38
Q

What are two most common ways that a cleft lip or palate defect is diagnosed?

A

During 18-21 week scan OR Newborn physical examination

39
Q

What drugs might cause neonatal abstinence syndrome?

A

Opioids / Barbiturates / Antidepressants / BDPs

40
Q

Signs of Neonatal Abstinence Syndrome

A

After ~72 hours after birth

  • Tremors), Seizures (convulsions), Overactive reflexes (twitching) and Tight muscle tone
  • Excessive crying or having a high-pitched cry
  • Poor feeding or sucking or slow weight gain
  • Breathing problems, including breathing really fast
  • Fever, sweating or blotchy skin
  • Trouble sleeping and lots of yawning
  • Diarrhea or throwing up
  • Stuffy nose or sneezing
41
Q

Prematurity is defined as birth before when?

A

37 weeks gestation

42
Q

WHO defines a very premature birth as birth at what gestation?

A

28-32 weeks

43
Q

Name a treatment option for tocolysis

A

In women with a history of preterm birth or an ultrasound demonstrating a cervical length of 25mm or less before 24 weeks gestation there are two options of trying to delay birth:

  • Prophylactic vaginal progesterone: putting a progesterone suppository in the vagina to discourage labour
  • Prophylactic cervical cerclage: putting a suture in the cervix to hold it closed

Where preterm labour is suspected or confirmed there are several options for improving the outcomes:

  • IV Atosiban
  • Tocolysis with nifedipine: nifedipine is a calcium channel blocker that suppresses labour
  • Maternal corticosteroids: can be offered before 35 weeks gestation to reduce neonatal morbidity and mortality
  • IV Magnesium sulphate: can be offered before 34 weeks gestation and helps protect the baby’s brain
  • Delayed cord clamping or cord milking: can increase the circulating blood volume and haemoglobin in the baby
44
Q

Name an issue in early life for a premature neonate and a long term effect

A

Issues In Early Life

  • Respiratory distress syndrome
  • Hypothermia
  • Hypoglycaemia
  • Poor feeding
  • Apnoea and bradycardia
  • Neonatal jaundice
  • Intraventricular haemorrhage
  • Retinopathy of prematurity
  • Necrotising enterocolitis
  • Immature immune system and infection

Long Term Effects

  • Chronic lung disease of prematurity (CLDP)
  • Learning and behavioural difficulties
  • Susceptibility to infections, particularly respiratory tract infections
  • Hearing and visual impairment
  • Cerebral palsy
45
Q

Name a sign/symptom, an investigation and a treatment for persistent pulmonary hypertension of the newborn

A

Signs and Symptoms

  • Fast breathing and fast heart rate
  • Grunting or moaning when breathing
  • Costal recession
  • Blue color of the lips or around the mouth or blue hands and feet (cyanosis)
  • Low blood oxygen levels, even after getting oxygen
  • Low blood pressure

Diagnosis

  • Echocardiogram (ECG)
  • X-Rays (lungs and can see if the heart is too large)
  • Blood tests (infection?)
  • Pulse Oximeter.

Treatment
Oxygen is given by:
- Nasal cannula. A small tube with prongs is placed in the nostrils.
- CPAP (Continuous Positive Air Pressure). This machine gently pushes air or oxygen into the lungs.
- Ventilator. This machine will breathe for your baby until the baby can breathe on his or her own. Intubation + hooked up to the ventilator. The ventilator is set to give the infant even and regular breaths.
- High frequency oscillation ventilation. This is a special type of ventilator. It can deliver rapid, short bursts of air through a breathing tube.

Medicines:

  • Blood pressure medicine to keep the blood pressure at the right level
  • Antibiotics to treat or prevent infection
  • Sedation medicine to help your baby rest and stay calm. When the baby is calm, the machines that give him oxygen can work better and he may need to use less.
  • Surfactant to help the lungs work better. Surfactant allows the lungs to use oxygen and get rid of carbon dioxide. It is given to the baby through a breathing tube.
46
Q

What are the two primary pulmonary problems underpinning congenital diaphragmatic hernias?

A

pulmonary hypertension and pulmonary hypoplasia

47
Q

Name a sign in the neonate with congenital diaphragmatic hernia

A
  • Cyanosis soon after birth.
  • Tachypnoea.
  • Tachycardia.
  • Asymmetry of the chest wall.
  • Absent breath sounds on one side of the chest, usually the left with the heart shifted to the right.
  • Bowel sounds audible over the chest wall.
    The abdomen possibly feels ‘less full’ on palpation.
48
Q

How is congenital diaphragmatic hernia diagnosed?

A

Ultrasound

49
Q

What is caput succedaneum, does it cross suture lines and what is the treatment?

A
  • Caput succedaneum involves fluid collecting on the scalp, outside the periosteum (caused by pressure to a specific area of the scalp during a traumatic, prolonged or instrumental delivery)
  • The fluid is outside the periosteum, which means it is able to cross the suture lines
  • It does not require any treatment and will resolve within a few days.
50
Q

A cephalohaematoma is a collection of blood between where, does it cross suture lines and what is the treatment?

A
  • Between skull and periosteum (caused by damage to blood vessels during a traumatic, prolonged or instrumental delivery)
  • The blood is below the periosteum, therefore the lump does not cross the suture lines of the skull (blood can cause discolouration of the skin in the affected area)
  • Usually a cephalohaematoma does not require any intervention and resolves without treatment within a few months
51
Q

Forceps delivery may cause what nerve injury?

A

Facial nerve injury

52
Q

An Erbs palsy is the result of injury to which cervical nerves in the brachial plexus during birth, leading to weakness in which movements?

A

C5/6 => weakness of shoulder abduction and external rotation, arm flexion and finger extension. This leads to the affected arm having a “waiters tip”

53
Q

Name a sign/symptom of a fractured clavicle in newborn?

A
  • Noticeable lack of movement or asymmetry of movement in the affected arm
  • Asymmetry of the shoulders, with the affected shoulder lower than the normal shoulder
  • Pain and distress on movement of the arm
54
Q

What is the most appropriate management of a hypoxic neonate to reduce hypoxic ischemic encephalopathy (HIE)?

A

Therapeutic cooling

55
Q

What do you call oedema of the scalp at the vertex, which may be due to mechanical trauma of the initial portion of the scalp pushing through the cervix in a prolonged delivery or secondary to the use of ventouse (vacuum) delivery?

A

Capput Succedaneum

  • soft, puffy swelling due to localised oedema
  • crosses suture lines
56
Q

The foramen ovale closes at birth to form what?

A

Fossa ovalis

57
Q

The ductus arteriosus and the ductus venosus close at birth to form what structures?

A

Ligamentum arteriosum and ligaments venosum

Phase 3a medicine (24 decks)

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