Paediatrics Flashcards
1
Q
Go look at the immunisation schedule
A
ok
2
Q
What vaccines are included in the 6-in-1 vaccine given at 2, 3, and 4 months old?
A
- Diphtheria
- Tetanus
- Whooping Cough (Pertussis)
- Polio
- Haemophilus influenzae type B (Hib)
- Hepatitis B
3
Q
At what ages is the Rotavirus vaccine given?
A
2 months old (1st dose)
3 months old (2nd dose)
4
Q
When is the first dose of the Meningitis B vaccine given?
A
At 2 months old.
5
Q
What 2 vaccines are given at 3 months old in addition to the 6-in-1 vaccine?
A
- Pneumococcal (PCV) vaccine (1st dose)
- Rotavirus vaccine (2nd dose)
6
Q
What is the vaccination schedule at 1 year old? (4)
A
- Hib/Meningitis C Booster (Hib 4th dose & Meningitis C)
- MMR (1st dose): Measles, Mumps, Rubella
- Pneumococcal (PCV) vaccine (2nd dose)
- Meningitis B vaccine (3rd dose)
7
Q
At what age is the flu vaccine given, and how often is it administered?
A
From 2 to 10 years old
Given annually
8
Q
What vaccines are included in the 4-in-1 pre-school booster given at 3 years and 4 months old?
A
- Diphtheria
- Tetanus
- Whooping Cough (Pertussis)
- Polio
9
Q
When is the second dose of the MMR vaccine given?
A
At 3 years and 4 months old.
10
Q
What vaccine is administered to children at 12/13 years old to prevent certain types of cancer?
A
The HPV vaccine (Human Papillomavirus), given in two doses 6-24 months apart.
11
Q
What vaccines are included in the 3-in-1 teenage booster given at 14 years old?
A
- Tetanus
- Diphtheria
- Polio
12
Q
What vaccine is given at 14 years old to protect against four types of meningitis?
A
The Meningitis ACWY vaccine.
13
Q
What is hypoxic-ischaemic encephalopathy (HIE)?
A
HIE is brain damage caused by prolonged hypoxia during birth, which can lead to long-term complications like cerebral palsy.
14
Q
Why are newborns particularly prone to rapid heat loss?
A
Newborns have a large surface area relative to their weight and are born wet, leading to rapid heat loss.
15
Q
What should be done to warm a baby during neonatal resuscitation?
A
Dry the baby vigorously and use a heat lamp. Preterm babies under 28 weeks should be placed in a plastic bag while still wet.
16
Q
What does the APGAR score assess, and when is it measured?
A
The APGAR score assesses the baby’s appearance, pulse, grimace, activity, and respiration. It is measured at 1, 5, and 10 minutes after birth.
17
Q
What should be done if a newborn is gasping or not breathing despite initial stimulation?
A
Administer two cycles of five inflation breaths (lasting 3 seconds each) and if needed, proceed to 30 seconds of ventilation breaths.
18
Q
When should chest compressions be initiated during neonatal resuscitation?
A
Start chest compressions if the heart rate remains below 60 bpm despite inflation breaths.
19
Q
What is the ideal ratio of chest compressions to ventilation breaths in neonatal resuscitation?
A
Perform chest compressions at a 3:1 ratio with ventilation breaths.
20
Q
What gas mixture should be used for inflation breaths in term and pre-term neonates?
A
Use air for term babies and a mix of air and oxygen for pre-term babies.
21
Q
What is the purpose of delayed umbilical cord clamping?
A
Delayed clamping allows for placental transfusion, which improves haemoglobin levels, iron stores, and blood pressure.
22
Q
What is a possible downside of delayed cord clamping in neonates?
A
Delayed clamping may increase the risk of neonatal jaundice, which could require phototherapy.
23
Q
In what situation should the umbilical cord be clamped early?
A
The cord should be clamped early if neonatal resuscitation is needed to avoid delays in treatment.
24
Q
Why is Vitamin K administered to newborns?
A
Newborns have a Vitamin K deficiency, which is vital for blood clotting. It prevents intracranial, umbilical stump, and gastrointestinal bleeding. The standard route is an intramuscular injection.
25
When is the newborn examination typically performed after birth?
A newborn examination should be performed within 72 hours after birth.
26
What is the purpose of the blood spot screening test? When is the blood spot screening test performed?
The blood spot screening test screens for nine congenital conditions using a heel prick to collect blood drops.
The blood spot test screens for nine conditions:
1. Sickle cell disease
2. Cystic fibrosis
3. Congenital hypothyroidism
4. Phenylketonuria
5. Medium-chain acyl-CoA dehydrogenase deficiency (MCADD)
6. Maple syrup urine disease (MSUD)
7. Isovaleric acidaemia (IVA)
8. Glutaric aciduria type 1 (GA1)
9. Homocystinuria
The blood spot test is done on day 5 (or by day 8) after birth, with parental consent.
27
What three questions should you ask parents before starting the newborn examination?
1. Has the baby passed meconium?
2. Is the baby feeding okay?
3. Is there a family history of congenital heart, eye, or hip problems?
28
What is the significance of pre- and post-ductal oxygen saturation differences?
Pre-ductal saturations are measured in the right hand, and post-ductal saturations are measured in either foot. More than a 2% difference between pre-ductal and post-ductal saturations may indicate a duct-dependent congenital heart condition.
29
How do you check for congenital cataracts or retinoblastoma in a newborn?
Use an ophthalmoscope to check the red reflex in both eyes.
30
What tests are performed to assess hip dislocation in a newborn?
Perform the Barlow’s and Ortolani’s manoeuvres to check for clunking, clicking, or hip dislocation.
31
What reflexes are checked during a newborn examination?
- Moro reflex
- Suckling reflex
- Rooting reflex
- Grasp reflex
- Stepping reflex
32
What are some common skin findings in newborns that generally don't require action?
- Milia
- Mongolian blue spot
- Erythema toxicum
- Cradle cap
- Transient pustular melanosis
33
What is Caput Succedaneum?
Caput succedaneum is oedema (fluid collection) on the scalp, outside the periosteum, caused by pressure during a prolonged or instrumental delivery. The fluid crosses the suture lines and resolves within a few days without treatment.
34
How does Caput Succedaneum differ from Cephalohaematoma?
Caput crosses the suture lines and involves fluid, whereas cephalohaematoma involves blood and does not cross the suture lines
35
What is Cephalohaematoma?
Cephalohaematoma is a collection of blood between the skull and periosteum, caused by trauma during birth. It can lead to discolouration and has a risk of anaemia and jaundice, but typically resolves without treatment.
36
What is Erb's Palsy, and what causes it?
Erb's palsy is caused by injury to the C5/C6 nerves in the brachial plexus during birth, often associated with shoulder dystocia or large birth weight. It results in a “waiter’s tip” arm posture with internal rotation of the shoulder, extended elbow, and flexed wrist.
37
What are the common organisms causing neonatal sepsis?
- Group B Streptococcus (GBS)
- Escherichia coli (E. coli)
- Listeria
- Klebsiella
- Staphylococcus aureus
38
Why is Group B Streptococcus (GBS) significant in neonatal sepsis?
GBS is commonly found in the vagina and can be transferred to the baby during labour, causing sepsis. Mothers with GBS may receive prophylactic antibiotics during labour to reduce this risk.
39
What are the key risk factors for neonatal sepsis?
- Vaginal GBS colonisation
- Previous baby with GBS sepsis
- Maternal sepsis or fever >38°C
- Prematurity (<37 weeks)
- Early rupture of membranes
- Prolonged rupture of membranes (PROM)
40
What are the red flags for neonatal sepsis?
- Confirmed or suspected maternal sepsis
- Signs of shock
- Seizures
- Term baby requiring mechanical ventilation
- Respiratory distress starting >4 hours after birth
- Presumed sepsis in a twin/multiple pregnancy sibling
41
What are the first-line antibiotics recommended for neonatal sepsis?
The NICE guidelines recommend:
- ***Benzylpenicillin and gentamycin*** as first-line antibiotics
- Cefotaxime (a third-generation cephalosporin) as an alternative for lower-risk cases
42
When should antibiotics be stopped in neonatal sepsis management?
- If the baby is clinically well, blood cultures are negative at 36 hours, and CRP is less than 10.
- If the baby remains well, lumbar puncture and blood cultures are negative at day 5, and CRP has normalised.
43
What are the causes of Hypoxic-Ischaemic Encephalopathy (HIE)?
- Maternal shock
- Intrapartum haemorrhage
- Prolapsed cord (cord compression during birth)
- Nuchal cord (cord wrapped around the baby's neck)
44
What are some indicators of suspected HIE in neonates?
- Events causing hypoxia in the perinatal or intrapartum period
- Acidosis (pH < 7) on the umbilical artery blood gas
- Poor Apgar scores
- Features of mild, moderate, or severe - HIE
- Multi-organ failure
45
What are the characteristics of Mild HIE (Sarnat staging)?
- Poor feeding
- Irritability and hyper-alertness
- Resolves within 24 hours
- Normal prognosis
46
What are the features of Moderate HIE? (Sarnat staging)
- Poor feeding, lethargy, hypotonia, and seizures
- Can take weeks to resolve
- Up to 40% develop cerebral palsy
47
What are the signs of Severe HIE (Sarnat staging)?
- Reduced consciousness, apnoeas, flaccidity, and reduced or absent reflexes
- Up to 50% mortality
- Up to 90% develop cerebral palsy
48
What is therapeutic hypothermia and how does it work in HIE management?
- Therapeutic hypothermia is a treatment where the baby's core temperature is reduced to between 33 and 34°C for 72 hours.
- It is used to reduce inflammation and neurone loss after hypoxic injury, lowering the risk of cerebral palsy, developmental delay, and death.-
49
What causes physiological jaundice?
- High red blood cell count in the fetus and neonate
- Fragile red blood cells
- Immature liver function
- Lack of placenta to help excrete bilirubin after birth
It usually appears 2-7 days after birth and resolves by 10 days.
50
What are some causes of neonatal jaundice related to increased production of bilirubin?
- Haemolytic disease of the newborn
- ABO incompatibility
- Cephalohaematoma
- Sepsis
- Polycythaemia
- G6PD deficiency
51
What are some causes of neonatal jaundice related to decreased clearance of bilirubin?
- Prematurity
- Breast milk jaundice
- Neonatal cholestasis
- Biliary atresia
- Endocrine disorders (e.g. hypothyroidism)
- Gilbert syndrome
52
What is the significance of jaundice within the first 24 hours of life?
Jaundice in the first 24 hours is considered pathological and requires urgent investigation and treatment. It is often linked to conditions like neonatal sepsis.
53
What is Haemolytic Disease of the Newborn (HDN)?
HDN is caused by rhesus incompatibility between the mother's and baby's blood. The mother's anti-D antibodies attack the fetus’s red blood cells, causing haemolysis and high bilirubin levels, leading to jaundice and anaemia.
54
What defines prolonged jaundice, and why is it significant?
Jaundice lasting longer than:
- 14 days in full-term babies
- 21 days in premature babies
This warrants investigation for underlying causes like biliary atresia or hypothyroidism.
55
What are the key investigations for jaundice in neonates?
- Full blood count and blood film
- Conjugated bilirubin levels
- Blood type testing (ABO or rhesus incompatibility)
- Direct Coombs Test for haemolysis
- Thyroid function tests
- Blood and urine cultures if infection is suspected
- G6PD levels for G6PD deficiency
56
How is jaundice in neonates managed?
- Total bilirubin levels are monitored and plotted on a treatment chart
- Phototherapy is used to reduce bilirubin levels
- In severe cases, exchange transfusion may be needed
- Monitor rebound bilirubin levels after phototherapy ends
57
How does phototherapy work for neonatal jaundice?
Phototherapy uses blue light to convert unconjugated bilirubin into isomers that can be excreted without liver conjugation. The baby is exposed to light with protective eye patches, and bilirubin levels are closely monitored.
58
What is kernicterus?
Kernicterus is a type of brain damage caused by high bilirubin levels crossing the blood-brain barrier, resulting in cerebral palsy, learning disabilities, and deafness. It presents with a floppy, drowsy baby and is now rare due to effective jaundice treatment.
59
What is apnoea in neonates?
Apnoea is defined as periods where breathing stops spontaneously for more than 20 seconds or for shorter periods if there is oxygen desaturation or bradycardia.
60
What are common causes of apnoea in neonates?
- Infection
- Anaemia
- Airway obstruction (may be positional)
- CNS pathology (e.g., seizures, haemorrhage)
- Gastro-oesophageal reflux
- Neonatal abstinence syndrome
61
What immediate management steps are taken for apnoea in neonates?
Tactile stimulation (such as gentle rubbing) is used to encourage the baby to start breathing again during an apnoea episode.
62
What medication can be used for recurrent apnoea in neonates?
Intravenous caffeine
63
What is Retinopathy of Prematurity (ROP)?
ROP is a condition affecting preterm and low birth weight infants, particularly those born before 32 weeks gestation. It involves abnormal blood vessel development in the retina, which can lead to scarring, retinal detachment, and blindness.
64
What is the pathophysiology of ROP?
- Normal retinal development begins around 16 weeks gestation and finishes by 37–40 weeks.
- Blood vessels develop in response to hypoxia, which is naturally present in the retina during gestation.
- In preterm babies, exposure to higher oxygen levels (often from supplemental oxygen) halts normal vessel development.
- Hypoxia may recur, leading to neovascularization (overgrowth of vessels) and scarring, risking retinal detachment.
65
Describe the retinal zones used in ROP assessment.
- Zone 1: Central area with the optic nerve and macula.
- Zone 2: Extends from the edge of Zone 1 to the ora serrata (the border of the retina and ciliary body).
- Zone 3: Area outside the ora serrata.
The retina is also described using clock-face notation (e.g., disease between 3 and 5 o’clock).
66
Which infants should be screened for ROP, and when?
Babies born before 32 weeks or under 1.5 kg should be screened:
- At 30–31 weeks gestation for babies born before 27 weeks.
- At 4–5 weeks of age for babies born after 27 weeks. Screening is done every 2 weeks until retinal vessels reach Zone 3, usually around 36 weeks gestation.
67
What does the ophthalmologist check during an ROP exam?
The retinal vessels are monitored for progression and any signs of plus disease (such as vessel tortuosity or hazy vitreous humour).
68
What is the first-line treatment for ROP?
Transpupillary laser photocoagulation is the first-line treatment, used to stop abnormal blood vessel growth.
69
What are other treatment options for ROP if laser treatment is insufficient?
Cryotherapy
Intravitreal VEGF inhibitors
Surgery (if there is retinal detachment)
70
What is Respiratory Distress Syndrome (RDS) and who does it affect?
RDS is a lung condition affecting premature neonates who have insufficient surfactant. It is common in babies born before 32 weeks gestation and results in respiratory distress.
71
What is the appearance of RDS on a chest X-ray?
RDS produces a "ground-glass" appearance on a chest X-ray, indicating the presence of fluid or collapsed alveoli.
72
What is the role of surfactant in the lungs, and what happens when it’s insufficient?
Surfactant reduces surface tension in the alveoli, allowing them to expand easily for proper gas exchange. When inadequate, it leads to high surface tension, alveolar collapse (atelectasis), hypoxia, hypercapnia (high CO₂), and respiratory distress
73
What is the primary management approach to prevent RDS?
Antenatal steroids (e.g., dexamethasone) are given to mothers at risk of preterm labor to boost fetal surfactant production, reducing the severity of RDS.
74
What treatments might a neonate with RDS require?
Treatments include:
- Intubation and ventilation for severe respiratory distress
- Endotracheal surfactant therapy to supply artificial surfactant directly to the lungs
- CPAP (Continuous Positive Airway Pressure) to maintain lung inflation
- Supplementary oxygen to keep oxygen saturation between 91–95%
75
What are short-term complications of RDS?
- Pneumothorax
- Infection
- Apnoea
- Intraventricular haemorrhage
- Pulmonary haemorrhage
- Necrotising enterocolitis
76
What are potential long-term complications of RDS?
- Chronic lung disease of prematurity
- Retinopathy of prematurity (often more severe in RDS cases)
- Neurological, hearing, and visual impairments
77
What is Necrotising Enterocolitis (NEC)?
NEC is a life-threatening condition in premature neonates where part of the bowel becomes necrotic. It can lead to bowel perforation, peritonitis, and shock.
78
What are the main risk factors for developing NEC?
- Very low birth weight or extreme prematurity
- Formula feeding (less common in breastfed babies)
- Respiratory distress and assisted ventilation
- Sepsis
- Patent ductus arteriosus and congenital heart disease
79
How does NEC typically present in neonates?
- Feed intolerance
- Green bile vomiting
- General unwellness
- Distended, tender abdomen
- Absent bowel sounds
- Blood in stools
80
What are the key investigations for diagnosing NEC?
Blood tests:
- Full blood count for thrombocytopenia and neutropenia
- CRP for inflammation
- Capillary blood gas showing metabolic acidosis
- Blood culture for sepsis
Abdominal X-ray (in the supine position) to detect:
- Dilated bowel loops
- Bowel wall edema
- Pneumatosis intestinalis (gas in the bowel wall)
- Pneumoperitoneum (free gas indicating perforation)
- Gas in the portal veins
81
What are the primary steps in managing NEC?
1. Nil by mouth with IV fluids and total parenteral nutrition (TPN)
2. Antibiotics to stabilize infection
3. Nasogastric tube insertion to drain fluids and gas
4. Referral to a neonatal surgical team (some cases may need surgery to remove necrotic tissue)
82
What surgical options might be required in NEC?
Surgery may be needed to remove necrotic bowel tissue. Some babies might require a temporary stoma if extensive tissue is removed.
83
What are possible complications of NEC?
- Perforation and peritonitis
- Sepsis and potential death
- Strictures and abscess formation
- Recurrence of NEC
- Long-term stoma
- Short bowel syndrome if extensive bowel is removed
84
What is Neonatal Abstinence Syndrome (NAS)?
NAS refers to the withdrawal symptoms seen in newborns of mothers who used substances during pregnancy. Each substance causes unique symptoms and may require different management approaches.
Substances that cause NAS include:
- Opiates
- Methadone
- Benzodiazepines
- Cocaine
- Amphetamines
- Nicotine or cannabis
- Alcohol
- SSRIs (antidepressants)
85
What are the common signs and symptoms of NAS in neonates?
CNS: Irritability, increased muscle tone, high-pitched crying, difficulty settling, tremors, and seizures.
Vasomotor and Respiratory: Yawning, sweating, temperature instability, pyrexia, and tachypnea.
Metabolic and Gastrointestinal: Poor feeding, regurgitation/vomiting, hypoglycemia, loose stools, and sore nappy area.
86
When do withdrawal symptoms typically start for various substances?
Opiates, diazepam, SSRIs, alcohol: 3 – 72 hours after birth.
Methadone, other benzodiazepines: 24 hours to 21 days after birth.
87
What initial management steps should be taken for neonates at risk of NAS?
1. Monitoring for at least 3 days (48 hours for SSRIs) using a NAS chart.
2. Urine sampling to test for substances.
3. Quiet, dim environment and gentle handling for comfort.
4. Medical alert in mother’s notes to ensure neonatal support and monitoring.
88
What are the medical treatment options for moderate to severe NAS symptoms?
- Oral morphine sulphate for opiate withdrawal.
- Oral phenobarbitone for non-opiate withdrawal. Neonates are gradually weaned off these treatments as symptoms improve.
89
What are the features of Fetal Alcohol Syndrome?
- Microcephaly (small head)
- Thin upper lip and smooth, flat philtrum
- Short palpebral fissure (short eye width)
- Learning disabilities, behavioral issues
- Hearing/vision problems and cerebral palsy
90
How can Congenital Rubella Syndrome (CRS) be prevented?
Prevention is through the MMR vaccine before pregnancy, as rubella is most dangerous in the first trimester. Pregnant women should not receive the MMR vaccine due to it being a live vaccine.
91
What are the signs of Congenital Rubella Syndrome?
Key features of CRS include:
- Congenital cataracts
- Congenital heart disease (e.g., PDA, pulmonary stenosis)
- Learning disabilities and hearing loss
92
How can varicella exposure in pregnancy be managed?
If non-immune, pregnant women exposed to varicella can receive IV varicella immunoglobulins within 10 days of exposure. Oral aciclovir may be given if a rash develops after 20 weeks.
93
What are the features of Congenital Varicella Syndrome?
- Fetal growth restriction
- Microcephaly and learning disabilities
- Scarring, limb hypoplasia
- Eye abnormalities (e.g., cataracts, chorioretinitis)
94
What are the effects of congenital CMV?
- Fetal growth restriction
- Microcephaly, hearing and vision loss
- Learning disabilities and seizures
95
How is toxoplasmosis transmitted and prevented in pregnancy?
Toxoplasmosis is spread by cat feces containing Toxoplasma gondii. Avoiding contaminated food and contact with cat litter helps prevent infection
96
What are the classic features of Congenital Toxoplasmosis?
The classic triad of congenital toxoplasmosis includes:
- Intracranial calcification
- Hydrocephalus
- Chorioretinitis
97
How is the Zika virus transmitted, and what risks does it pose during pregnancy?
Zika is spread by Aedes mosquitos and sexual transmission. In pregnancy, it can lead to microcephaly and intracranial abnormalities.
98
What features are associated with Congenital Zika Syndrome?
- Microcephaly
- Fetal growth restriction
- Intracranial abnormalities like ventriculomegaly and cerebellar atrophy
99
What are the main risk factors associated with SIDS?
- Prematurity
- Low birth weight
- Smoking during pregnancy
- Being a male baby (slight increase in risk)
100
How can the risk of SIDS be minimized?
- Placing baby on their back when unsupervised
- Keeping their head uncovered
- Positioning their feet at the foot of the cot to prevent sliding under blankets
- Maintaining a clear cot (no excess toys or blankets)
- Ensuring a comfortable room temperature (16–20°C)
- Avoiding smoking and handling the baby after smoking
- Avoiding co-sleeping, especially on sofas or chairs
- Avoiding alcohol, drugs, or sleeping pills if co-sleeping
