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Paediatrics > Paediatrics Core Conditions > Flashcards

Paediatrics Core Conditions Flashcards

1
Q

Within the new-born and neonatal period. List the common conditions within this time period

A 
Neonatal Jaundice*
Birth Asphyxia/ HIE*
Birth marks
Cephalohaematoma
Haemolytic D of the new-born
Prematurity & Small baby
Respiratory distress syndrome (RDS)
Talipes
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2
Q

What are red flag symptoms in neonates < 1 week old?

A 
Cyanosis
Still limbs
Temp > 37.5, <35.5
Severe chest recessions
Grunting
RR >60
Poor feeding
Seizures
Lethargy
Movement when stimulated
Cap refil  3 secs
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3
Q

Neonatal jaundice is raised blood [bilirubin] causing yellowing of the skin/eyes.
(conjugated or unconjugated)

What % of new-borns are affected by this?

A

60%

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4
Q

Within what time frame is visible jaundice a concerning feature?

What could cause this?

A

< 24hrs

  • Haemolytic D of new-born (Rh incompatibility
  • ABO incompatibility
  • RBC abnormality
  • Congenital infection (TORCH)
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5
Q

Jaundice can occur within 24hrs - 2 weeks of birth.

List causes of jaundice within this time frame.

A 
Physiological
Breast-feeding, Breast milk
Sepsis, any infection
Bruising/ birth trauma, polycythaemia, G^DP def
Criggler-Najjar syndrome
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6
Q

Jaundice can occur > 2 weeks after birth.

List causes of jaundice after 2 weeks.

A 
Physiological
Breast-feeding, Breast milk
Sepsis, any infection incl UTI
Hypothyroid
Haemolytic anaemia
GI ob: *Biliary atresia, pyloric stenosis, neonatal Hep B
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7
Q

A 3 day old baby comes into the CAT unit with mother as she notices he has yellow eyes and a tinge to his skin.

The baby was delivered vaginally at 38 weeks with no complications or visits to SCBU. He has been struggling to feed as he has a cleft palate.

What blood tests would you order to investigate?

What are your top differentials?

A

BLOODS: FBC, Blood film, Septic screen incl urinalysis, LFTs

Differentials: Physiological, Breast-feeding, Infection

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8
Q

A 14 hour-old baby with Down’s syndrome was born with a C-section. The mother has amniocentesis as a diagnostic test for the Down’s. This was the mother’s second child, the first one did not develop jaundice.

The baby now develops jaundice.

What investigations would you do?

What is the most likely cause?

A

BLOODS: FBC, Blood film, Direct Coombs test, Blood groups, TORCH screen

Haemolytic D of the new-born (sensitisation in 1st preg, trauma from amniocentesis so mixing of blood for antibodies to be produced)

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9
Q

What are the red flags of neonatal jaundice?

A

Lethargy
Poor feeding
Hypertonia, Opisthotonus (kernicterus)

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10
Q

Depending on the level of bilirubin in the blood. What are the orders of treatment for neonatal jaundice?

A

Nothing
Phototherapy
Exchange blood transfusion

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11
Q

Bilirubin is toxic to neurones. If neonatal jaundice is not treated or a severe [c] then what rare complication can it lead to?

A

Kernicterus

= irreversible brain damage

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12
Q

Birth asphyxia is a serious condition where foetal hypoxia/ischaemia occurs from impaired gas exchange before/during/ after birth.

What are the risk factors?

A

Multiple preg
Prematurity
Acute maternal infection

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13
Q

What circumstances can cause birth asphyxia?

A

Birth depression, breech delivery
Prolonged labour
Aspiration - meconium, amniotic fluid, mucus
Foetal malnutrition, placental insufficiency

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14
Q

When examining a newborn using the Apgar score, you can look for signs of birth asphyxia.

  1. What does Apgar stand for?
  2. How often do you do it?
  3. What score is considered critically low?
A
  1. Appearance, Pulse, Grimace, Activity, Respirations
  2. 1,5, 10 mins after birth
  3. 0-3 = critically low
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15
Q

Birth asphyxia manifests in drop In BP, drop in HR, altered U&Es and neurological signs from organ-failure.

How is it managed?

A

Neonatal resuscitation (ABC, tone)

Therapeutic hypothermia (34 degrees for 3 days)

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16
Q

If birth asphyxia is severe, the complication is _____________________.

This requires intensive care. It is graded by clinical manifestations from then to 48hrs

20% go on to develop _____________

What other neurological disorders can a baby develop?

A

Hypoxic ischaemic encephalopathy (HIE)

Cerebral palsy

Other: Epilepsy, learning difficulties, behavioural problems, blindness, deafness, hydrocephaly, microcephaly

17
Q

Birth marks are very common.

What are the two types of birth marks?

List examples in each group

A

VASCULAR

  • Superficial haemangioma (Strawberry naevus)
  • Stork mark (most common ~50%)
  • Port-wine stain

PIGMENTED

  • Congenital melanocytic naevus
  • Mongolian blue spot
  • Café au lait ( If >6 then NF1)
18
Q

A 7 hour-old baby, delivered at 35 weeks is sleeping in the maternal unit in her cot. She and mother are waiting to be discharged after the midwife does the new-born examination.

You notice a soft rounded protrusion in the left parietal region of the baby’s head.

What do you think it is?
What caused it?
How do you manage it?
What are potential complications?
How long will it take to resolve?
A

Cephalohaematoma

Caused by haematoma from birth trauma

Do CT (detect underlying skull #)

complications: anaemia, jaundice, hypotension

Several weeks to resolve

19
Q

How would you define haemolytic disease of the newborn?

What blood incompatibilities can cause this?

A

= antibody-mediated response where mothers Ab attack the antigens on the baby’s RBC causing haemolysis

  • Rhesus
  • ABO
20
Q

How does haemolytic D of the newborn present in utero & post-natally?

A

In utero: Hydrop foetalis (abdo swells from hepatosplenomegaly to rapidly replace lost RBC) –> portal HTN –> red albumin production –> oedema)

Post-natally: Jaundice < 24hrs. Signs of anaemia - pale

21
Q

What investigations would you do antenatally vs postnatally to detect haemolytic D of the newborn?

A

Antenatally:

  • Indirect Coombs test (looking for Anti-D in Rh -ve mum)
  • USS (hydrops foetalis)
  • Foetal blood sample: Blood group, FBC, Blood film (only if Doppler confirms anaemia)

Postnatally

  • Direct Coomb’s test
  • FBC, blood film
  • Blood group
  • LFTs (baseline bilirubin)
22
Q

A 17 hour-old baby has jaundice and the direct coomb’s test shows anti-D antibodies in the babies blood. His Hb is low but blood film normal. His blood group is 0. His baseline bilirubin is 250.

How would you manage him?

A

Management same as neonatal jaundice (depends on [c]:
Nothing OR
Phototherapy OR
Exchange blood transfusion

23
Q

40% of pre-term labour are idiopathic.

Other causes include multiple preg, maternal illness: UTI, preeclampsia, Diabetes. Compromised uterine/placenta and lifestyle factors e.g. smoking, malnutrition.

What are the figures for the catagories for the birth weights?

A

Low birth weight = < 2.5kg
Very low birth weight = < 1.5kg
Extremely low birth weight = < 1kg

24
Q

A baby is delivered at 30 weeks due to maternal preeclampsia. The baby is taken to SCBU.

What are the common complications in premature babies?

A 
RDS, Apnoea, birth asphyxia
Hypoglycaemia (immature liver/ pancreas)
Hypothermia (thin skin, less fat)
Jaundice (lower threshold)
Infections (low Ig)
Diff feeding (small mouth)
Necrotising entercolitis (from too much/ early feed)
Intraventricular haemorrhage
Retinopathy of the premature
25
Q

How is a premature baby managed to sustain them and prevent complications?

A

Incubator - warmth, prevent infection +/- Phototherapy
Manage sugars
Given surfactant if RDS
Non-oral feeding if too premature/ unwell
Good infection control - aprons, gloves, limited personelle

26
Q

The two reasons for a small baby are ____________ and _______________

In IUGR a baby small for gestational age (SGA) where they are less than the ______ percentile.

A

Prematurity
Intrauterine Growth Restriction (IUGR)

< 10th

27
Q

The two types of SGA babies are those that are symmetrically or asymmetrically small.

List causes in both categories.

A

SYMMETRICALLY SGA

  • Congenital infection: TORCH
  • Chromosomal Ab
  • Maternal D
  • Maternal alcohol use

ASYMETRICALLY SGA

  • Toxaemia of preg = Pre-eclampsia
  • Multiple preg
  • Placental insufficiency
  • Maternal smoking
28
Q

A small baby is generally managed in the same way as a premature baby.

What investigations might you perform?

If hey are not premature but are just SGA. What 2 things are important to manage?

A

TORCH screen

Manage hypoglycaemia
Early feeding

(less chance of RDS in IUGR as foetal distress causing steroid release so lung maturity)

29
Q

The most common diagnosis in premature babies is _______________

What are the risk factors?

A

Respiratory distress syndrome (RDS)

Risk factors: prematurity, multiple preg - 2nd twin, maternal diabetes, males, C-section

30
Q

How does RDS occur?

A

Surfactant starts to be produced in 30 weeks gestation.
If premature –> less/immature type 2 pneumocytes –> surfactant def –> atelectasis of alveoli –> re-inflation exhausts baby –> resp distress/failure

31
Q

Signs of RDS include: _________

What are 3 red flags signs in RDS?

You order a CXR to confirm RDS and see a ground glass appearance. How would you manage RDS?

A

Signs: chest recessions, grunting, nasal flaring
RR > 60
Cyanosis*

Red flags: reduced consciousness, reduced resp effort, cyanosis

Management: ABCDE
Give surfactant

32
Q

Mothers at risk of premature delivery will be given Dexamethasone from 23-35 weeks to prevent RDS.

True or False?

What are the differentials of a new-born in respiratory distress?

A

True

Differentials:

  • RDS
  • Transient tachypnoea of newborn
  • Aspiration - meconium, amniotic, mucus
  • Infection: pneumonia, sepsis
  • Diaphragmatic hernia
  • Pneumothorax
33
Q

Talipes equinovarus is also known as _________

It occurs in ~ _____ births. 50% are bilateral

What are the causes of talipes?

What examination would you do if a baby has Talipes?

How is it managed?

A

Clubfoot

1 in 1000

Causes: Idiopathic. Ass: genetic syndrome/ congenital ab (20%), DDH, spina bifida, oligohydroamnios

Exam: Ortolani, Barlow

Manage: Ponsetti method (–> Surgery)

34
Q

+ve Ortolani test is when you flex at he hip and knee and abduct knee and you hear a ______ noise. It is aiming to re-locate the dislocated knee

Barlow’s test aims to _______ the hip. The hip is already flexed and knee flexed maximally. Within gentle pressure you push down the knee towards the hip joint. It causes a clickly noise.

You perform with one hip at a time. Then do saddle hip for bilateral dislocation.

A

Clicky

Disolocate

Paediatrics (2 decks)

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