Paediatrics - neonatology Flashcards
What score is used to assess the health of a baby immediately after birth?
APGAR
What does APGAR stand for?
- Activity (muscle tone)
- Pulse
- Grimace (reflex irritability)
- Appearance (skin colour)
- Resp rate
When is the APGAR score measured?
- 1 minute
- 5 minute
… after birth, at 10 min if low
What is APGAR scored out of and what is a good/ bad score?
- < 4 bad
- 5-6 ok
- 7< good
out of 10
What should all babies be given ASAP following birth?
Vitamin K IM injection
all babies born deficient
What checks should be done soon after birth (2)?
- NIPE
- Hearing test (ottoscoustic emission test)
How soon after birth should a NIPE be done?
Within 72 hours
What are some causes of respiratory distress in the newborn (5)?
- Respiratory distress syndrome = mc (in premature infants)
- Transient tachypnoea of the newborn = mc overall
- Meconium aspiration
- Sepsis/ pneumonia
- Pneumothorax
What is respiratory distress syndrome of prematurity?
Disease causing difficulty breathing due to inadequate surfactant production
What gestational age are babies born at risk of respiratory distress syndrome?
32 weeks or below
What is the pathophysiology of respiratory distress syndrome?
Inadequate surfactant –> high surface tension –> atelectasis (partial lung collapse –> inadequate gaseous exchange
What are the signs/ symptoms of RDS on oximetry and observation (3)?
- Hypoxia
- Hypercapnia
- Respiratory distress (accessory muscles, tachypnoea, intercostal recession, etc…)
How would RDS of prematurity appear on xray?
Ground glass appearance
How is RDS managed (3)?
- Antenatal steroids (mature lungs)
- Endotracheal surfactant
- O2/ CPAP/ intubation + ventilation (if severe)
What are some complications of RDS (3)?
- Pneumothorax
- Infection
- Chronic lung disease of prematurity (bronchopulmonary dysplasia)
amongst many other complications
What is the cause of bronchopulomary dysplasia/ chronic lung disease of prematurity?
Chronic high flow oxygen as a baby –> reperfusion injury
What are the signs/ symptoms of bronchopulmonary dysplasia/ chronic lung disease of prematurity (3)?
- Chronic respiratory distress
- Recurrent chest infections
- Poor feeding + FTT
What would a CXR show for those with BPD/CLDOP?
Widespread opacity
How is BPD/CLDOP treated (5)?
- Vitamin A
- Caffeine
- Corticosteroids (to mother)
- CPAP/ O2
- Palivizumab/ vaccinations
What is palivizumab?
Monoclonal antibody against RSV
What is transient tachypnoea of the newborn?
Residual pulmonary fluid remains in lung tissue after delivery –> tachypnoea + resp distress
What is a finding on x ray of those with transient tachypnoea of the newborn?
Fluid in the horizontal fissure
How is TTON treated (2)?
- O2 (if sats low)
- CPAP (if more severe)
What is the mechanism aspirated meconium occurs?
Meconium shat into amniotic fluid –> foetus inhales amniotic fluid –> irritates the lungs
What is a risk factor for aspirated meconium?
Post term
What are the signs/ symptoms of aspirated meconium(2)?
- Meconium stained amniotic fluid
- Resp distress Sx
What are the findings on x ray of those with aspirated meconium (2)?
- Consolidation
- Patchy atelectasis
How is aspirated meconium treated (3)?
- Suction
- O2
- Abx
What is a complication of aspirated meconium?
Persistent pulmonary hypertension of the newborn
mc cause of death following meconium aspiration
How is persistent pulmonary hypertension of the newborn treated (2)?
- Viagra
- NO2
What is a common breathing disorder in premature infants?
Apnoea of prematurity
should not happen in term infants
(3)How is apnoea of prematurity treated?
- Apnoea monitor
- Tactile stimulation
- IV caffeine
What is necrotising enterocolitis?
Death and inflammation (sometimes with infection) of bowel tissue for an unknown reason
When does NEC typically occur after birth?
2-4 weeks
What is the main group of neonates affected by NEC?
Premature babies
can occur in term infants however very rare
Other than prematurity what are some other risk factors for NEC (3)?
- Low birth weight
- Formular fed
- Indomethacin (decreases mesenteric blood flow)
What is indomethacin and what is it used for?
NSAID - used to close a PDA
What are the signs/ symptoms of NEC (5)?
- Abdo distension (erythematous taught skin)
- Bilious vomiting
- Absent bowel sounds
- Bloody stool
- Poor feeding
How is NEC investigated?
- FBC (thrombocytopenia, neutropenia)
- Blood cultures
- Abdo X-ray (supine, front on)
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
How is NEC managed (3)?
- IV fluids + total parenteral feed
- Abx
- Laparotomy (remove dead bowel)
What are some complications of NEC (4)?
- Perforation
- Sepsis/ DIC/ shock
- FTT
- Short bowel syndrome
Where is the most common site of oesophageal atresia?
Proximal oesophagus
What do more distal oesophageal atresia sometimes present as?
Tracheoesophageal fistula
What are some risk factors for oesophageal atresia (3)?
- Trisomes (esp downs)
- IVF
- VACTERAL association (a group of linked birth defects)
What are the VACTERAL defects (6)?
- Vertebral defects
- Anal atresia
- Cardiac defects
- Tracheoesophageal fistula
- Renal anomalies
- Limb abnormalities
What are the symptoms/ signs of oesophageal atresia (4)?
- Polyhydramnios (due to not being able to swallow amniotic fluid)
- Cough
- Choke
-
Cyanotic
the 3 Cs
How is oesophageal atresia diagnosed?
X-ray
unable to pass NG tube
How is oesophageal atresia treated?
Anastomosis surgery ASAP
What is the most common bowel atresia?
Duodenal atresia
Where does the atresia usually occur in the duodenum?
Just past the ampulla of vater
What are some risk factors for duodenal atresia (4)?
- Downs = 1/3rd cases
- VACTERAL
- IVF
- Annular pancreas
What is an annular pancreas?
Pancreas wraps around duodenum
How is duodenal atresia diagnosed (2)?
- Antenatal scan
- X-ray
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
How is duodenal atresia managed (3)?
- NG decompression
- IV fluid
- Duodenoduodenostomy
What is jaundice?
Abnormally high levels of bilirubin
How is bilirubin usually excreted?
RBC –> unconjugated bilirubin –> conjugated bilirubin (in liver) –> excreted in bile/ urine
What are some causes of neonatal jaundice (6)?
- Physiological jaundice
- Sepsis (TORCH infections)
- HDN/ ABO incompatibility
- Biliary atresia
- Hypothyroidism
- CF
What timeframe is physiological jaundice normal/ expected?
- 24 hours –> 2 weeks
jaundice should not occur outside of this window
What causes of neonatal jaundice would present within 24 hours of birth (2)?
- Sepsis
- HDN/ ABO incompatibility
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
When is jaundice prolonged in premature neonates?
After 21 days
Why is jaundice more likely in premature neonates?
They have an underdeveloped liver therefore cannot conjugate bilirubin as effectively
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
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
How is neonatal jaundice managed (2)?
- Phototherapy
- Exchange transfusion (if severe)
How can bilirubin levels be monitored if neonatal jaundice is present?
Transcut bilirubin monitor
What is a complication of neonatal jaundice?
Kernicterus (build up of unconjugated bilirubin in the CNS)
What long term affects can Kernicterus have (3)?
- Deafness
- Cerebral palsy
- Learning disability