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Paediatrics Flashcards

1
Q

How many neonates died globally in 2020?

A

2.4 - 2.6 million cases

Highest incidence in areas which are experiencing significant conflict

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2
Q

82% of neonatal deaths are attributable to three main causes. What are they?

A

Preterm birth (16%)
Infection (11%)
Complications during childbirth, including hypoxic ischaemic encephalopathy (birth asphyxia)

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3
Q

When do most neonatal deaths occur?

A

First 24h (± 1 million deaths)

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4
Q

What SDG is focused on addressing neonatal mortality?

A

SDG 3: ‘Good Health and wellbeing’

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5
Q

What is the Every Newborn Action Plan (ENAP)?

A

A document which aims to galvanise the global community to improve neonatal outcomes

AIMS:
1. Prevent all avoidable neonatal deaths
2. End preventable stillbirths

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6
Q

What is essential newborn care?

A
  • The care that every newborn baby needs, regardless of where it is born or its size

Encompasses days 1-7 of life

Aim: prevent early deaths

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7
Q

What are the key steps of Essential Newborn Care?

A
  1. Keep baby warm (skin to skin)
  2. breathing support
  3. Early initiation of breastfeeding
  4. Kangaroo care to support small babies (BW <2000g)
  5. Protect baby from HIV (PEP)
  6. Vit K and immunisations
  7. monitor baby for ‘danger’ signs
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8
Q

What urgent vaccines do you give to the newborn/

A
  1. Hepatitis B
  2. BCG
  3. Vitamin K
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9
Q

When should you advise chlorhexidine cleaning of the cut cord site?

A

4% chlorhexidine gel for home deliveries in settings with NMR >30 per 1000 live births)

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10
Q

What are neonatal ‘danger signs’

A
  1. Cessation of feeding
  2. Hypothermia / pyrexia
  3. Grunting, fast or slow RR , cyanosis, chest in-drawing
  4. Eye and skin infection
  5. Jaundice in <24h
  6. Abdo distension –> omphalitis, ,blood oozing from umbilical stump, persistent vomiting
  7. CNS - floppy baby, convulsions
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11
Q

What is ophthalmia neonatorium?

A

red, swollen discharging eyes

Caused by maternal chlamydia / gonorrhoea

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12
Q

What antibiotics does the WHO recommend for neonatal sepsis?

A

Ampicillin + Gentamicin (7/7)

**There are differences in local guidelines

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13
Q

What are the two types of neonatal sepsis?

A
  1. Early Onset
  2. Delayed (late) onset
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14
Q

What is early onset neonatal sepsis?

A

infection within the first 72h of life

Represents vertical meternal - child transmission

Associated with pneumonia, meningitis

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15
Q

What infection is implicated with early onset neonatal sepsis?

A

GBS

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16
Q

When does late onset neonatal sepsis occur?

A

manifestations of sepsis 3-7 days after birth

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17
Q

What maternal infections can be passed to the baby?

A

Rubella
toxoplasmosis
Syphilis
Cytomegalovirus
Zika
Chickenpox
HSV
HIV
Hep B
GBS

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18
Q

What are risk factors in neonatal sepsis?BC

A

Pre-PROM/PROM
Chorioamnionitis
Maternal pyrexia / GBS carriage
Home delivery

Prematutiry
low BW
Congenital abnormalities
complicated delivery

Unclean birth conditions

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19
Q

What are important organisms in neonatal sepsis?

A

Staph Aureus (25%
Listeria
E Coli
Strep spp.
GBS
Klebsiella

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20
Q

Where are gram -ve infections most likely in the neonate?

A

South East Asia, Asia, Russia

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21
Q

How do you diagnose neonatal sepsis?

A
  1. Blood Cultures (0.5 - 1ml of blood)
  2. Blood tests (CRP, white cells)
  3. ± LP (normal LP is likely to have WCC up to 10 in a newborn)
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22
Q

What oragnism is implicated in tetanus?

A

Clostridium tetani

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23
Q

What is the mortality rate of tetanus in neonates?

A

85%

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24
Q

When do you suspect neonatal tetanus?

A

ability to suck at birth and for first few days followed by inability to suck starting between 3 and 10 days of age, spasms, stiffness, convulsions and death

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25
Q

How many tetanus injections does a mother require to prevent transmission to her baby?

A

3 tetanus toxoid boosters

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26
Q

How does CMV present in the neonate?

A

Hepatosplenomegaly
Jaundice
Microcephaly
Hydrocephalus
Petichial rash
IUGR

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27
Q

How does Toxoplasmosis present in the neonate?

A

Hepatosplenomegaly
Jaundice
Microcephaly
Hydrocephalus
Petichial rash
IUGR
Viral exanthem
Eye findings
Adenopathy

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28
Q

How does Rubella present in the neonate

A

Hepatosplenomegaly
Jaundice
petichial rash
Heart defects
Bony lesions
IUGR
Adenopathy
Eye findings

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29
Q

What is Hypoxic Ischaemic Encephalopathy? (HIE)

A
  1. Significant event causing
    hypoxia or ischaemia
  2. Poor condition at birth – need
    for resuscitation, Apgar <5 at 5
    minutes
  3. Multi-organ failure
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30
Q

What causes HIE?

A

placental insufficiency
uterine rupture
prolong/obstructed labour
inadequate resuscitation

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31
Q

What are the clinical consequences of HIE?

A

Seizures (biggest cause of seizures in term/preterm babies world wide
Poor tone
Death
Resp Apnoea/Failures

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32
Q

What are the APGARs?

A

Appearance (colour)
Pulse
Grimace (reflex)
Activity (tone)
Respiration
Hypotension
Metabolic Acidosis
Hypoglycaemia
Hyponatraemia
AKI
Poor UO
Feed intolerances
DIC

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33
Q

When should an APGAR score be calculated?

A

A minutes 1, 5 and 10 post delivery

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34
Q

What is the Helping Babies Breathe document?

A

A neonatal resus guideline (simple) which can be used globally

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35
Q

What is the ‘Golden Minute’ in neonatal birth?

A

the baby should be breathing within the first 60 seconds of life

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36
Q

What ventilation advice does the Helping Babies Breathe document suggest (different from UK guidelines)

A

If baby has required assistance w/ ventilation?

Ventilate for 1 minute –> reassess
If HR <60 continue ventilating

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37
Q

What is the definition of extremely low birth weight (eLBW)?

A

weight at birth <1000g

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38
Q

What is the definition of very low birth weight (vLBW)

A

1001-1500g

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39
Q

What is the defition of LBW?

A

<2500g

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40
Q

What are the definitions related to prematurity?
- moderate to late preterm

A

32-37 weeks

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41
Q

What are the definitions related to prematurity?
- Very preterm

A

28-32 weeks

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42
Q

What are the definitions related to prematurity?
- Extremely preterm

A

<28 weeks

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43
Q

What are the risk factors for pre-term birth?

A
  • Not known!! (the most common situation!!)
  • Multiple pregnancies
  • Maternal infections (e.g. malaria, urinary tract infections/pyelonephritis, HIV)
  • Inadequate birth spacing
  • Maternal undernutrition (height <145 cm)
  • Complications of pregnancy (pre-eclampsia, gestational diabetes)
  • Maternal chronic disease (hypertension)
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44
Q

What strategies could be implemented to reduce the risk of pre-term birth?

A
  • Optimising maternal nutrition.
  • Addressing adolescent and unplanned pregnancies (contraceptives).
  • Timely and appropriate management of infections in pregnancy.
  • Preventing tobacco and substance abuse.
  • Adequate antenatal care (8 contacts with health professionals).
  • Social support
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45
Q

How many babies die each year when born pre-term?

A

1 million

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46
Q

What are the long-term outcomes of pre-term birth?

A

Visual and hearing impairment (retinopathy of prematurity)
Learning difficulties
Poor growth
Susceptibility to infections in infancy
Stigma

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47
Q

Who should receive antenatal steroids?

A

Babies who are at a risk of premature birth between 24-34 weeks if:

  • gestational age assessment can be accurately undertaken;
  • preterm birth is considered imminent (within 7 days);
  • there is no clinical evidence of maternal infection;
  • adequate childbirth care is available;
  • the preterm newborn can receive adequate care if needed;

**must be used in a facility where women and baby can be assessed for infection, and have infection subsequently managed

** dexamethasone in the correct conditions reduces all cause mortality (apart from infection)

48
Q

Continuous positive airway pressure therapy is recommended for the treatment of preterm newborns with respiratory distress syndrome.

Why does it work?

A
  • Reduced need for mechanical ventilation (~50%)
  • Less resource intensive
  • Reduction in RDS mortality (~30%)
  • Reduction in bronchopulmonary dysplasia
  • Reduced time in establishing enteral feeds
49
Q

How should LBW infants be fed?

A

breast feed ASAP from birth

50
Q

How should vLBW infants be fed?

A

Enteral feeds from day 1 (breast milk) 10ml/kg increasing feeds by 30ml/kg/day

51
Q

What are common causes of atrumatic coma in children?

A

Cerebral Malaria
Meningitis
Neuro abscess
Hypoglycaemia
Hepatic failure
ICH
SAH
ADEM
Dengue
Measles

52
Q

What is the Balantyre Coma Scale?

53
Q

How do you approach the child with coma?

A

Airway
- Recovery position, clear airway, Intubate, NG Tube

Breathing
- O2 and Ventilation

Circulation
- IV Access, Fluids

Disability
- IV Abx
- IV Artesunate
- Glucose

54
Q

What are common causes of convulsions in children?

A

Febrile seizures
CNS infection
Cerebral malaria
Cerebral abscess
Hypoglycaemia
Hypoxia
Trauma
Vascular accidents (would be pretty uncommon unless SCD)

55
Q

How do you manage convulsions?

A
  1. O2
  2. check BM
  3. Antibiotics: Ceftriaxone 100mg/kg
  4. Artesunate <20kg = 3mg/kg, >20kg 2.4mg/kg

±Diazepam (or midazolam/lorazepam if avilable!) IV/PR
± phenobarbitol IM/IV (or phenytoin)

56
Q

What is the dose of diazepam to terminate status in paeds?

A

Diazepam IV: 0.25mg/kg

57
Q

What is the loading dose of phenobarbital in seizure cessation?

A

LOADING: 15mg/kg IV over 15 min

MAINTENANCE: 5mg/kg OD for 2/7

58
Q

Which neonatal infected site is most associated with tetanus infection?

A

Omphalitis

59
Q

How many children under 5 died in 2019?

A

5.2 million

60
Q

When is a child lethargic?

A. The child will not wake, even after shaking

B. The child is sleeping more often than usual, but will wake up if you set them down to walk

C. The child is drowsy and will not follow movement or noise in the room

61
Q

The IMCI (Integrated Management of Childhood illness) gives generic guidelines for management of common childhood illness.

What ages do they aim their guidance at?

A

2m - 5years

62
Q

How do you manage a child <12m with severe dehydration and shock?

A
  1. 30ml/kg over one hour –> 70ml/kg over 5h
    ±2. 70ml/kg of Hartmanns over 5 hours
  2. Reassess - switch to ORS as soon as patient able to drink (5ml/kg/hour)
63
Q

How do you manage a child >12m with severe dehydration and shock?

A
  1. 30ml/kg over 30 min –> 70ml/kg over 2.5h
    ±2. 70ml/kg of Hartmanns over 2.5h
  2. Reassess and switch to ORS as soon as patient able to drink (5ml/kg/hour)
64
Q

Which neonates should be given prophylatic antibiotics?

What is the antibiotic of choice?

A

Give prophylactic antibiotics only to neonates with documented risk factors for infection:

  • Membranes ruptured > 18 h before delivery
  • Mother had fever > 38 °C before delivery or during labour.
  • Amniotic fluid was foul-smelling or purulent

Give IM or IV ampicillin and gentamicin for at least 2 days

65
Q

How much fluid per day should the neonate gat over the first 3 days of life?

A

Day 1 60 ml/kg per day
Day 2 90 ml/kg per day
Day 3 120 ml/kg per day
Then increase to 150 ml/kg per day

66
Q

What is Opthalmia Neonatorium?

A

Neonatal conjunctivitis, usually secondary to gonorrhoea. Can lead to blindness so prompt rx. necessary

Ceftriaxone stat + eye ointment (cholamphenical/tetracycline)

67
Q

Give 3 symptoms/examination findings of severe diarrhoea in the child?

68
Q

How do you manage Cholera in a child?

A
  1. Manage dehydration
  2. Antibiotics: Erythromycin/ciprofloxacin/co-trimoxazole
  3. Zinc until Diarrhoea stops

** All children with diarrhoeal illness should get Zinc supplements

69
Q

What are the features of Severe Acute Malnutrition?

A

■ weight-for-length/height < -3SD
(wasted)
or
■ mid-upper arm circumference
< 115 mm
or
■ oedema of both feet (kwashiorkor
with or without severe wasting).

70
Q

How do you manage, in hospital, a child with Complication SAM?

A
  1. Antibiotics –> Broad spectrum, IV Benpen and IV Gent
  2. Hypoglycaemia control: 50ml of 10% glucose if will tolerate PO, otherwise IV
  3. Hydration (slow - do not treat the same as shock): ReSoMal 5ml/kg every 30 min for the first 2h then reassess
  4. Measles Vax (unless in shock)
  5. Eye disease: Chloramphenical drops and Vitamin A supplements
  6. Kwashiorkor skin: Zinc
71
Q

What is EPI?

A

Expanded Programme on Immunisation:

Goal: to make immunization against diphtheria, pertussis, tetanus,
poliomyelitis, measles and tuberculosis available to every child in the world by 1990

Help by GAVI, the vaccine alliance, which aims to vaccinate all children, especially focusing on the countries with most missed childhood vaccinations

72
Q

What are the main 7 EPI vaccines?

A

bacillus Calmette-Guérin vaccine (BCG)
Oral polio vaccine (OPV)
Diphteria-pertussis-tetanus (DPT)
Hepatitis B
Measles
Yellow fever vaccine
Tetanus toxoid

±Haemophilus influenzae type b (Hib)
Rotavirus
Neisseria meningitidis Group A
Human papillomavirus (HPV)
Pneumococcal conjugate vaccine (PCV)
Typhoid
Varicella, Malaria, Dengue, Ebola

73
Q

What is the basic EPI vaccination schedule for the first year of life?

A

Birth: OPV0 + BCG
6 weeks: OPV1 + DPT1
10 weeks: OPV2 + DPT2
14 weeks: OPV3 + DPT3
9-12 months: Measles, Yellow Fever

74
Q

Pedro is 9 months old. His sister has brought him to the clinic for the measles vaccine.

It is 15 minutes before closing time. You would have to open a new 10-dose bottle. If you opened the bottle the rest of the bottle (9 doses) would be wasted.

What would you do?

A. Open the bottle and give the vaccine
B. Ask his sister to come back tomorrow

A

A. Open the bottle and give the vaccine

75
Q

Name 3 vaccines which cannot be frozen

76
Q

If you are concerned that an unfreezable vaccine has been frozen, what can you do to check?

A

The Shake Test

To check whether freeze-sensitive
vaccines have been damaged by exposure to temperatures below
0 °C

  • Needed if a freeze indicator has been activated, or temp recordings show negative temps
77
Q

What is Noma?

A

Necrotising Gingivitis

Infection affect children <7 years old

OI, mostly occurring in areas of severe poverty

Often occurs in the context of malnutrition, measles, HIV

78
Q

How do you manage Noma?

A

Penicillin + Metronidazole

Refeeding

Assess for parasitic infection, malaria, anaemia, HIV

Offer surgical follow up in a year

Case fatality 70-90% if untreated

79
Q

In which two countries is Polio still endemic?

A

Afghanistan
Pakistan

80
Q

What Form of meningitis classically occurs within the meningitis belt?

A

Meningitis A
- Caused an epidemic which killed 25000 people in the 90s

MenAfriVac exists to reduce

81
Q

The proportion of vaccines for children typically wasted is

A. 5%
B. 10%
C. 20%
D. >30%
E. 50%

82
Q

What temperature does a measles vaccine need to be kept at?

A. -8 to -2 °C
B. -8 to -4 °C
C. -2 to 2 °C
D. 2 to 8 °C
E. 4 to 8 °C

83
Q

Which of the following vaccines can be frozen at HQ?

A. Measles
B. Diphtheria
C. Pertussis
D. Oral polio
E. Conjugate polysaccharide vaccines

84
Q

IMCI recommends asking about 4 specific symptoms. What are they?

A

Cough
Diarrhoea
Fever
Ear symptoms

85
Q

SDG 3 has a specific goal about mortality in U5s - what is it?

A

Sustainable Developmental Goal (SDG) 3 aims to reduce under-5 mortality in all countries to at least as low as 25/1000 live births by 2030.

86
Q

Give 5 differentials of Fever and a rash in a child

A

Bacterial: Meningococcal meningitis, pnuemococcus, scarlet fever (strep pyogenes), Leptospirosis, Typhoid

Viral: Parvovirus, Measles, Rubella, Adenovirus, HHV6 (roseola infantum), Dengue, Chikungunya, Yellow Fever

Rickettsial infections: Spotted fevers, Scrub typhus, typhus group

87
Q

Name 4 bacteria which cause meningitis in children

A

Meningococcal
Pneumococcal
HiB
Group B Strep

88
Q

Give a differential (5) of causes of myocarditis in a child

A

Viral
* Adenovirus
* Parvovirus B19
* Coxsackie virus
* Enteroviruses

Bacterial
* Brucella
* Mycoplasma
* Mycobacteria
* Typhoid fever

Fungal
* Aspergillus

Parasites
* Visceral larva migrans,
schistosomiasis

Non-infective
* Heavy metal, chemotherapy,
hyperpyrexia

89
Q

Give 5 management steps for convulsions in a child

90
Q

How long should you wait before attempting to terminate an absence seziure in a child

A

15 minutes

91
Q

Name 3 ETAT emergency signs (red flags) in a child

A
  • obstructed or absent breathing
  • severe respiratory distress
  • central cyanosis
  • signs of shock, defined as cold extremities with capillary refill time >3s and a weak, fast pulse
  • coma (or seriously reduced level of consciousness)
  • seizures
  • signs of severe dehydration in a child with diarrhoea with any two of these signs: lethargy or unconscious,
    sunken eyes, very slow
  • return after pinching the skin
92
Q

Name 3 main organisms in Bacterial Meningitis in the neonate

A

Group B Strep
Strep Pneumoniae
Listeria
E Coli

93
Q

Name 3 main organisms in Bacterial Meningitis in children

A

Group B Strep
Strep Pneumonia
Niseria Meningitis
Haemophilus Influenzae
Mycobacterium Tuberculosis

94
Q

What is ETAT?

A

Emergency Triage, Assessment and Treatment

A triage system used to determine which children in LMICs are the most unwell on admission

Found that ETAT can help reduce child mortality in the first 24-48h of hospital admission

95
Q

What is Diptheria?

A

Bacterial infection causing acute membranous pharyngitis with fever

96
Q

What is the epidemiology of Diptheria?

A

Children > Adults
Unvaccinated populations

97
Q

How does Diptheria present?

A

Fever
Pharyngitis
Gray fibrous adherent membrane on throat
Stridor
Bull neck from lymphadenopathy

98
Q

What is the differential of Diptheria?

A

Quinsy
EBV
Bacterial Tonsillitis
Melioidosis (Parotitis)
Lymphangitis
Cutaenous Vesicles with Eschars

99
Q

How is Diptheria Diagnosed?

A

Nasopharyngeal swab:
- Culture
- PCR

ELEK test (rarely done as quite technical)

100
Q

What toxin is assocaited with Diptheria?

A

AB Toxin (same as in Cholera)

101
Q

How is Diptheria spread?

102
Q

How is Diptheria managed?

A

Diptheria Equine Antitoxin + BenPen for 14/7
+
Immunisation / booster
+
F/U in 3-6 months to check for complications

103
Q

What are the complications of Diptheria infection?

A

Mortality 5-10% (although some cases say up to 40%)

Airway Obstruction
Myocarditis
Polyneuropathy
Renal Failure
Local tissue necrosis

NOTE: Diptheria bacteria does not spread throughout the body; complications occur as a result of the AB toxin in diptheria, which is why you should give Anti-toxin as soon as possible

104
Q

What organism causes Diptheria?

A

Corynebacterium diphtheriae

105
Q

From a PH point of view, how do you prevent outbreaks of diptheria?

A
  1. Contact tracing
    – throat swab and PCR
  2. Erythromycin to contacts for 7/7
  3. Vaccine coverage assessment –> administer as required
  4. Follow up
106
Q

How many doses of Diptheria Vaccines does a child need to get?

107
Q

What are risk factors for a Diptheria outbreak?

A

Poor vaccine coverage
Overcrowding
Refugee/Emergency settings

108
Q

In which countries is Diphtheria still a significant problem?

A

India
Nigeria
Ethiopia
Pakistan
Indonesia

109
Q

What is the most likley diagnosis in a 7 day old child?

110
Q

What organism causes Tetanus

A

Clostridium Tetani

111
Q

What is the differential diagnosis of spasm (incl. lock jaw and opisthotonus). Give 5 causes (child or adult)

A

Neonates

tetanus
hypocalcaemia
hypoglycaemia
meningitis
meningoencephalitis
seizures

Adults

Tetanus
Dental abscess
Orofacial infections
Meningitis
Tetany (hypocalcaemia)
Strychnine poisoning
Drug induced dystonic reactions
Neuroleptic malignant syndrome
Oculogyric crisis (metoclopramide)
Rabies

112
Q

How do you manage tetanus?

A

Treat with wound debridement, tetanus antitoxin, penicillin or metronidazole and intensive
supportive treatment (tracheostomy, ventilation, benzodiazepines, morphine, muscle
relaxants, magnesium)
Adequate wound management important to prevent development of tetanus

113
Q

What are the main causes of penumonia in children <5

A

Strep Penumonia
H. Influenzae
RSV
Adenovirus
Influenze

114
Q

How can we prevent Strep Pneumoniae?

A

Pneumococcal Conjugate Vaccine
PCV13

** all children should receive at least 3 doses

115
Q

What is the commonest cause of bacterial meningitis in children <5

A

H. Influenza

116
Q

Give a differential for causes of emyema in children (name 3)

A
  • S pneumoniae
  • S aureus
  • Group A streptococci.
  • H influenzae rarely
  • Anaerobic infections secondary to aspiration.
  • Fungal or mycobacterial infections in immunosuppressed patients.
  • Mycoplasma pneumoniae and viruses can rarely result in exudative pleural effusions.

DTM&H (29 decks)

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