Paediatrics - neonatology Flashcards
1
Q
What score is used to assess the health of a baby immediately after birth?
A
APGAR
2
Q
What does APGAR stand for?
A
- Activity (muscle tone)
- Pulse
- Grimace (reflex irritability)
- Appearance (skin colour)
- Resp rate
3
Q
When is the APGAR score measured?
A
- 1 minute
- 5 minute
… after birth, at 10 min if low
4
Q
What is APGAR scored out of and what is a good/ bad score?
A
- < 4 bad
- 5-6 ok
- 7< good
out of 10
5
Q
What should all babies be given ASAP following birth?
A
Vitamin K IM injection
all babies born deficient
6
Q
What checks should be done soon after birth (2)?
A
- NIPE
- Hearing test (ottoscoustic emission test)
7
Q
How soon after birth should a NIPE be done?
A
Within 72 hours
8
Q
What are some causes of respiratory distress in the newborn (5)?
A
- Respiratory distress syndrome = mc (in premature infants)
- Transient tachypnoea of the newborn = mc overall
- Meconium aspiration
- Sepsis/ pneumonia
- Pneumothorax
9
Q
What is respiratory distress syndrome of prematurity?
A
Disease causing difficulty breathing due to inadequate surfactant production
10
Q
What gestational age are babies born at risk of respiratory distress syndrome?
A
32 weeks or below
11
Q
What is the pathophysiology of respiratory distress syndrome?
A
Inadequate surfactant –> high surface tension –> atelectasis (partial lung collapse –> inadequate gaseous exchange
12
Q
What are the signs/ symptoms of RDS on oximetry and observation (3)?
A
- Hypoxia
- Hypercapnia
- Respiratory distress (accessory muscles, tachypnoea, intercostal recession, etc…)
13
Q
How would RDS of prematurity appear on xray?
A
Ground glass appearance
14
Q
How is RDS managed (3)?
A
- Antenatal steroids (mature lungs)
- Endotracheal surfactant
- O2/ CPAP/ intubation + ventilation (if severe)
15
Q
What are some complications of RDS (3)?
A
- Pneumothorax
- Infection
- Chronic lung disease of prematurity (bronchopulmonary dysplasia)
amongst many other complications
16
Q
What is the cause of bronchopulomary dysplasia/ chronic lung disease of prematurity?
A
Chronic high flow oxygen as a baby –> reperfusion injury
17
Q
What are the signs/ symptoms of bronchopulmonary dysplasia/ chronic lung disease of prematurity (3)?
A
- Chronic respiratory distress
- Recurrent chest infections
- Poor feeding + FTT
18
Q
What would a CXR show for those with BPD/CLDOP?
A
Widespread opacity
19
Q
How is BPD/CLDOP treated (5)?
A
- Vitamin A
- Caffeine
- Corticosteroids (to mother)
- CPAP/ O2
- Palivizumab/ vaccinations
20
Q
What is palivizumab?
A
Monoclonal antibody against RSV
21
Q
What is transient tachypnoea of the newborn?
A
Residual pulmonary fluid remains in lung tissue after delivery –> tachypnoea + resp distress
22
Q
What is a finding on x ray of those with transient tachypnoea of the newborn?
A
Fluid in the horizontal fissure
23
Q
How is TTON treated (2)?
A
- O2 (if sats low)
- CPAP (if more severe)
24
Q
What is the mechanism aspirated meconium occurs?
A
Meconium shat into amniotic fluid –> foetus inhales amniotic fluid –> irritates the lungs
25
What is a risk factor for aspirated meconium?
Post term
26
What are the signs/ symptoms of aspirated meconium(2)?
* Meconium stained amniotic fluid
* Resp distress Sx
27
What are the findings on x ray of those with aspirated meconium (2)?
* Consolidation
* Patchy atelectasis
28
How is aspirated meconium treated (3)?
* Suction
* O2
* Abx
29
What is a complication of aspirated meconium?
Persistent pulmonary hypertension of the newborn
*mc cause of death following meconium aspiration*
30
How is persistent pulmonary hypertension of the newborn treated (2)?
* Viagra
* NO2
31
What is a common breathing disorder in premature infants?
Apnoea of prematurity
*should not happen in term infants*
32
(3)How is apnoea of prematurity treated?
* Apnoea monitor
* Tactile stimulation
* IV caffeine
33
What is necrotising enterocolitis?
Death and inflammation (sometimes with infection) of bowel tissue for an unknown reason
34
When does NEC typically occur after birth?
2-4 weeks
35
What is the main group of neonates affected by NEC?
Premature babies
*can occur in term infants however very rare*
36
Other than prematurity what are some other risk factors for NEC (3)?
* Low birth weight
* Formular fed
* Indomethacin (decreases mesenteric blood flow)
37
What is indomethacin and what is it used for?
NSAID - used to close a PDA
38
What are the signs/ symptoms of NEC (5)?
* Abdo distension (erythematous taught skin)
* Bilious vomiting
* Absent bowel sounds
* Bloody stool
* Poor feeding
39
How is NEC investigated?
* FBC (thrombocytopenia, neutropenia)
* Blood cultures
* **Abdo X-ray** (supine, front on)
40
What would an abdominal x-ray show in those with NEC (3)?
* Pneumatosis intestinalis (gas in bowel)
* Pneumoperitoneum (gas in abdominal cavity)
* Dilated bowels, thickened walls
41
How is NEC managed (3)?
* IV fluids + total parenteral feed
* Abx
* Laparotomy (remove dead bowel)
42
What are some complications of NEC (4)?
* Perforation
* Sepsis/ DIC/ shock
* FTT
* Short bowel syndrome
43
Where is the most common site of oesophageal atresia?
Proximal oesophagus
44
What do more distal oesophageal atresia sometimes present as?
Tracheoesophageal fistula
45
What are some risk factors for oesophageal atresia (3)?
* Trisomes (esp downs)
* IVF
* VACTERAL association (a group of linked birth defects)
46
What are the VACTERAL defects (6)?
* Vertebral defects
* Anal atresia
* Cardiac defects
* Tracheoesophageal fistula
* Renal anomalies
* Limb abnormalities
47
What are the symptoms/ signs of oesophageal atresia (4)?
* Polyhydramnios (due to not being able to swallow amniotic fluid)
* **C**ough
* **C**hoke
* **C**yanotic
*the 3 **C**s*
48
How is oesophageal atresia diagnosed?
X-ray
*unable to pass NG tube*
49
How is oesophageal atresia treated?
Anastomosis surgery ASAP
50
What is the most common bowel atresia?
Duodenal atresia
51
Where does the atresia usually occur in the duodenum?
Just past the ampulla of vater
52
What are some risk factors for duodenal atresia (4)?
* Downs = 1/3rd cases
* VACTERAL
* IVF
* Annular pancreas
53
What is an annular pancreas?
Pancreas wraps around duodenum
54
How is duodenal atresia diagnosed (2)?
* Antenatal scan
* X-ray
55
What is the x-ray finding for those with duodenal atresia?
'Double bubble' sign
*stomach and first part of duodenum filled with air, and separated by the pyloric sphincter*
56
How is duodenal atresia managed (3)?
* NG decompression
* IV fluid
* Duodenoduodenostomy
57
What is jaundice?
Abnormally high levels of bilirubin
58
How is bilirubin usually excreted?
RBC --> unconjugated bilirubin --> conjugated bilirubin (in liver) --> excreted in bile/ urine
59
What are some causes of neonatal jaundice (6)?
* Physiological jaundice
* Sepsis (TORCH infections)
* HDN/ ABO incompatibility
* Biliary atresia
* Hypothyroidism
* CF
60
What timeframe is physiological jaundice normal/ expected?
* 24 hours --> 2 weeks
*jaundice should not occur outside of this window*
61
What causes of neonatal jaundice would present within 24 hours of birth (2)?
* Sepsis
* HDN/ ABO incompatibility
62
Why does physiological jaundice occur in the newborn (2)?
* Foetal haemoglobin breaks down faster than adult haemoglobin, therefore more bilirubin produced
* Baby no longer has access to placenta for excretion of bilirubin
63
When is jaundice prolonged in premature neonates?
After 21 days
64
Why is jaundice more likely in premature neonates?
They have an underdeveloped liver therefore cannot conjugate bilirubin as effectively
65
What is a risk factor for the development of physiological neonatal jaundice?
Being breast fed
*for various reasons including components of breast milk that inhibit liver, more likely for baby to become dehydrated*
66
How is neonatal jaundice investigated (4)?
* FBC, U&E, LFTs, TFT
* Bilirubin levels
* Maternal vs baby blood type
* Blood cultures (for sepsis)
*investigate general causes of anaemia*
67
How is neonatal jaundice managed (2)?
* Phototherapy
* Exchange transfusion (if severe)
68
How can bilirubin levels be monitored if neonatal jaundice is present?
Transcut bilirubin monitor
69
What is a complication of neonatal jaundice?
Kernicterus (build up of unconjugated bilirubin in the CNS)
70
What long term affects can Kernicterus have (3)?
* Deafness
* Cerebral palsy
* Learning disability
71
What is biliary atresia?
Bile duct either stenosed or absent
72
What are the symptoms of biliary atresia (4)?
* Prolonged jaundice
* Pale stool
* Dark urine
* Distended stomach
73
What blood finding would suggest biliary atresia?
High levels of **conjugated** bilirubin
74
How is biliary atresia treated?
Kasai portoenterostomy
*section of small intestine attached to opening of liver*
75
What are two conditions that cause the herniation of abdo contents outside the abdomen?
* Gastroschisis
* Exomphalus (omphalocele)
76
What defect is seen in gastroschisis vs exomphalus?
* Gastroschisis = bowel protrudes **without** peritoneal covering through abdominal wall (usually to the right of the umbilicus)
*Gastro**shit**is = shit my pants because no peritoneal covering*
* Omphalocele = bowel protrudes through umbilicus covered by a layer of peritoneum
***O** for shape of umbilicus*
77
Which type of abdominal content herniation seen in neonates is much more commonly associated with other congenital defects?
Omphalocele
78
How should gastroschisis be managed?
Immediate repair
79
How should exomphalus/ omphalocele be managed?
Usually staged repairs over 12 month period (depends on size)
80
How should foetuses with gastroschisis/ exomphalus be delivered?
C-section
81
What is neonatal hepatic syndrome?
Collection of disorders that cause liver dysfunction in newborns
82
What are some causes of neonatal hepatic syndrome (4)?
* Viral infections
* Metabolic disorders (galactosemia, A1AT deficiency)
* Biliary tract disorders (coledochal cyst, biliary atresia)
* Idiopathic
83
What is galactosemia?
Deficiency in enzymes that metabolise milk leading to a build up of galactose in the blood which can damage organs such as the liver
84
What are a group of infections that are problematic in pregnancy and can pass from the mother to foetus/ newborn (5)?
* **T**oxoplasmosis
* **O**ther
* **R**ubella
* **C**MV
* **H**SV
85
What is a congenital infection?
Infection passed from mother to child during pregnancy
86
What are some general symptoms/ signs of congenital TORCH infections (5)?
* Neonatal jaundice
* Polyhydramnios
* Rash in newborn (blueberry muffin rash)
* Growth restriction
* Hepatosplenomegally
87
What are the 'other' organisms in the TORCH acronym infections (5)?
* **Syphilis**
* VZV
* Parovirus B19
* HIV
* Hep B
88
What are the risks to the foetus/ newborn associated with maternal toxoplasmosis infection (3)?
**Classic triad**
* Hydrocephalus
* Intracranial calcifications
* Chorioretinitis
*also increases the risk of miscarriage*
89
How is toxoplasmosis complications in the neonate investigated?
MRI shows intracranial calcifications
90
How is congenital toxoplasmosis treated (2)?
* Pyrimethamine
* Sulfadiazine
*spiramycin for mother*
91
What effects does congenital syphilis infection have on the newborn (4)?
* Deafness
* Changes to teeth (hutchinson incisors)
* Visual problems (interstitial keratitis)
* Rash
92
When is the baby most at risk of congenital syphilis?
New maternal infection in the last trimester of pregnancy
93
How is congenital syphilis treated?
IM benzathine benzylepenicilin
94
What are the symptoms of congenital rubella in an infant (4)?
* Deafness
* Cataracts
* Congenital heart disease (PDA, pulm stenosis)
* Learning disability
95
When is congenital rubella usually passed on?
First 20 weeks of pregnancy
96
What are the symptoms of congenital CMV (4)?
Vague Sx:
* Foetal growth restriction
* Microcephaly
* Hearing, vision loss
* Seizures
97
Do most maternal CMV infections result in congenital CMV?
No, it is usually not passed to foetus
98
How is CMV infection treated?
Ganciclovir
99
How is congenital HSV usually contracted?
Exposure to mothers genital lesions at time of delivery
100
What are the symptoms of congenital HSV (3)?
* Localised infection around skin/ mouth
* Encephalitis
* Disseminated infection
101
What ware the symptoms of HSV encephalitis (4)?
* Fever
* Headache
* Seizures
* Focal neurological defects
102
How should babies be delivered if the mother has HSV?
C-section
*if there are active lesions*
103
How is congenital HSV treated?
Aciclovir
104
What are risks associated with VZV infection during pregnancy (3)?
* More severe infection in mother
* Foetal varicella syndrome
* Neonatal varicella infection
105
What are the options for treating VZV in pregnancy (2)?
* **Aciclovir** if > 20 weeks
* VZ Igs
106
What is a symptom of congenital VZV infection?
Limb hypoplasia
107
What are the two types of neonatal sepsis in terms of when symptoms appear?
* Early onset (<72 hours)
* Late onset (>72 hours)
108
What is the most common cause of early onset neonatal sepsis?
Group B strep (strep agalactiae)
109
What are some other causes of early onset neonatal sepsis not including GBS (2)?
* E. coli
* Listeria monocytogenes
110
What are the symptoms of GBS sepsis in a neonate (5)?
* **!!!Respiratory distress!!!**
* Poor feeding
* Fever
* Reduced tone
* Reduced urine output
111
What does neonatal sepsis often present as/ start as before becoming sepsis?
Neonatal meningitis
112
Where does GBS usually live/ reside?
In the GI tract/ vagina
*so neonate is infected during birth*
113
How is early onset neonatal sepsis treated - which Abx (2)?
* Benzylpenicilln
* Gentamycin
114
What are some risk factors for neonatal sepsis (4)?
* Vaginal GBS colonisation
* Prematurity/ low birth weight
* Prolonged rupture of membranes
* Maternal sepsis
115
How should neonatal sepsis be investigated (4)?
* FBC, CRP
* Blood cultures
* LP
* VBG = metabolic acidosis due to tissue hypoxia and anaerobic metabolism
*neonatal sepsis can also lead to resp acidosis or mixed acidosis if resp failure occurs*
116
How can neonatal sepsis be prevented in mothers who's vaginal swabs are positive for GBS?
Intrapartum IV benzylpenicilin
117
What is the ongoing management of neonatal sepsis (2)?
* Check CRP at 24 hours and blood cultures at 36 hours if negative stop antibiotics
* Check CRP and blood cultures again at 5 days if still on treatment
118
What causes listeria infections in mothers/ newborns?
Unpasteurised dairy products, meats
**Blue cheese**
119
What are 2 causes of late onset neonatal sepsis?
* Staph epidermidis (coagulase negative staphylococcal species)
* Staph aureus
*bacteria from surrounding hospital environment*
120
What is cleft lip/ palate?
A congenital split/ open section of upper lip/ palate (soft or hard)
121
What percentage of defects are cleft lip, what percentage are cleft palate, what are both?
* Lip = 40%
* Palate = 15%
* Both = 45%
122
How is cleft lip and cleft palate treated?
* Cleft lip = surgical correction at **3 months**
* Cleft palate = surgical correction at **6-12 months**
123
What conditions can having cleft lip/ palate put you at higher risk of developing later in life (2)?
* Glue ear/ ear infection
* Hearing problems
124
What are babies with cleft lip/ palate at risk of and how can this be mitigated against?
Difficulties eating/ drinking
*babies can use specially shaped bottles/ teats*
125
What is cleft lip/ palate associated with?
Other congenital defects affecting facial development (Pierre robins, treacher collins) + pataus + DiGeorge
*often occur spontaneously on its own however*
126
What is neonatal hypoglycaemia?
Low blood sugar in neonates usually considered < 2.6mmol/l
127
When is neonatal hypoglycaemia most common?
First 24 hours of life
128
What are the symptoms of neonatal hypoglycaemia (6)?
* Jittery
* Floppy
* Drowsy
* Poor feeding
* Tachypnoea
* Hypothermia
129
How is neonatal hypoglycaemia treated (2)?
* Asymptomatic + > 2 mmol/l = encourage feeding
* Symptomatic OR < 2 mmol/l = IV 10% dextrose
130
What are some risk factors for neonatal hypoglycaemia (4)?
* Preterm
* Maternal diabetes
* IUGR
* Sepsis
131
What is hypoxic ischemic encephalopathy?
Hypoxia + ischemia to the brain at/ around the time of birth
132
What is the pathophysiology of HIE (2)?
* Ischemia causes damage to the brain
* Reperfusion after ischemia causes a repercussion injury causing even more damage
133
What causes HIE (4)?
* Maternal shock
* Intrapartum haemorrhage
* Prolapsed cord
* Nuchal cord
134
What is a nuchal cord?
Cord around babys neck
135
What criteria are used to stage HIE into mild, moderate or severe?
Sarnat criteria
136
What are the mild symptoms of HIE (3)?
* Poor feeding
* Irritable
* Hyper-alert
137
What are the moderate symptoms of HIE (3)?
* Lethargic
* Hypotonic
* Seizures
138
What are the severe symptoms of HIE (3)?
* Reduced consciousness
* Apnoeas
* Reduced/ absent reflexes
139
What are some complications of HIE (4)?
* Intraventricular haemorrhage
* Cerebral palsy
* Development delay
* Epilepsy
140
How is HIE investigated (3)?
* ABG
* Glucose
* USS/ MRI head
*in children at risk/ suspected HIE*
141
How is HIE managed (3)?
* ABCDE
* Supportive care
* Therapeutic hypothermia
142
What is therapeutic hypothermia?
Neonates with HIE can have their body temp cooled to reduce the risk of damage from hypoxia
143
When is alcohol consumption in pregnancy the most damaging?
First 3 months
144
What are some effects of alcohol consumption on early pregnancy (3)?
* Miscarriage
* Small for dates
* Preterm delivery
145
What is it known as when babies of mothers who have drunk display certain characteristics?
Fetal alcohol syndrome
146
What are the signs/ symptoms of fatal alcohol syndrome (6)?
* Thin upper lip
* Microcephaly
* Smooth flat philtum (groove between nose and lip)
* Small eyes
* CP/ learning disability
* Hearing/ visual problems
147
What is neonatal abstinence syndrome?
Withdrawal symptoms that happen in neonates who's mothers used substances
148
What are the signs/ symptoms of neonatal abstinence syndrome (6)?
* Irritability
* Increased tone
* Sweating/ poor temperature control
* Tachypnoea
* Poor feeding
* Vomiting
149
How can neonatal abstinence syndrome be managed (2)?
* Opiate withdrawal = **morphine sulphate**
* Other substances = **phenobarbitone**
*SSRI withdrawal does not need to be treated*
150
What condition can affect the vision of babies born prematurely?
Retinopathy of prematurity
151
What is the pathophysiology of retinopathy of prematurity?
Hypoxic womb environment --> retinal blood vessel development --> in premature baby, retina exposed to high oxygen environment (supplemental O2) --> no stimulant for BV development --> when hypoxic environment recurs --> excessive BVs + scar tissue formation
152
What are 2 risk factors for ROP?
* Low birth weight
* Prematurity
153
How is retinopathy of prematurity picked up?
All babies under 32 weeks or under 1.5 kg should be screened every 2 weeks for ROP
154
How is ROP treated?
Laser eye surgery (transpupillary laser photocoagulation)
*holts and reverses nerovascularisation*
155
What are two injuries that may occur to the scalp during delivery?
* Caput succedaneum
* Cephalohaematoma
156
What is caput succedaneum vs cephalohaematoma?
* Caput succedaneum = oedema outside the periosteum
* Cephalohaematoma = blood collecting under the periosteum
157
What is the periosteum?
Membranous lining of the bone
158
How can caput succedaneum and cephalohaematoma be distinguished upon examination?
* Caput succedaneum crosses the suture lines of the head
* Cephalohaematoma does not cross the suture lines of the head (well demarcated)
*this is because the periosteum connects to the bone at the suture lines preventing the blood from spreading out*
159
What nerves are sometimes injured during delivery (2)?
* Facial nerve
* Brachial plexus (C5/6)
160
What is a risk factor for facial nerve paralysis associated with delivery?
Forceps delivery
161
What does damage to the facial nerve present as?
Weakness on one side
*usually resolves on its own, otherwise will need neurosurgical input*
162
What is damage to the brachial plexus (C5/6) during delivery known as?
Erbs palsy
163
What are some risk factors for Erbs palsy (2)?
* Shoulder dystocia
* Traumatic/ instrumental delivery
164
What position would a baby with Erbs palsy be in?
* Internally rooted shoulder
* Extended elbow
* Flexed wrist facing backwards
**Waiters Tip**
165
What injury during delivery may be associated with asymmetry/ lack of movement of an arm?
Clavicle fracture
166
What are the signs/ symptoms/ features of non accidental injury (4)?
* Multiple bruises in non-mobile child (esp tummy/ thighs)
* Anal fissures
* Recurrent UTIs
* Delayed presentation
167
Who should be notified if NAI suspected?
Child protection services/ social services
168
What act allows a child to talk to doctor without guardian in room?
Child act 2004
169
How is NAI investigated (3)?
* FBC
* Clotting screen
* Full body X-ray
170
What are some differentials for a non accidental injury (2)?
* Bleeding disorders
* ITP
171
What effects can maternal hyperthyroidism have on the baby (4)?
* Low birth weight
* Preterm
* Neonatal hyperthyroidism (if TSH receptor antibodies cross placenta)
* Tachycardia
172
What are the effects of gestational diabetes on the baby (5)?
* Macrosomia
* Neonatal hypoglycaemia
* RDS
* Prematurity
* Increased risk of diabetes later in life
173
What is it known as when babys suddenly die for an unexplained reason?
Sudden infant death syndrome
174
What are some risk factors for sudden infant death syndrome (5)?
* Prematurity
* Low birth weight
* Smoking in house + during pregnancy
* Male
* Prone sleeping
175
How can the risk of sudden infant death syndrome be reduced (4)?
* Lie baby on its back
* Keep the babys head uncovered
* Don't smoke
* Don't sleep in same bed
