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Stage 3 > Paediatrics: Neonatology + Heart Defects > Flashcards

Paediatrics: Neonatology + Heart Defects Flashcards

1
Q

What is the definition for early onset neonatal sepsis?

A

Onset < 72h of life

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2
Q

What can cause early onset neonatal sepsis?

A

1) Ascending microorganisms from the cervix e.g. during delivery - Group B Strep
2) Trans-placental - listeria, toxoplasma, rubella, CMV

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3
Q

What are the features of maternal GBS infection?

A

1) GBC commonly colonises the genital tract
2) Can cause asymptomatic bacteriuria or UTI in the mother
3) No routine screening for GBS in the UK

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4
Q

What can be used to treat GBS in the mother?

A

IV benzylpenicillin

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5
Q

What are indications for maternal GBS treatment?

A

1) Previous baby infected with GBS
2) Maternal fever
3) Positive swab/bacteriuria at any point in the pregnancy

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6
Q

What are risk factors for early onset neonatal sepsis?

A

1) In cases of multiple pregnancies - where another baby has a suspected or confirmed infection
2) GBS confirmed in a previous baby OR evidence of GBS in current pregnancy
3) Prematurity
4) ROM > 18 hours for pre-term babies
5) ROM > 24h for term babies
6) Maternal intrapartum temperature > 38
7) Suspected/confirmed maternal sepsis
8) Chorioamnionitis

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7
Q

What is the definition for late onset neonatal sepsis?

A

Onset > 72h of life (7-28 days)

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8
Q

What is the most common cause of late onset neonatal sepsis?

A

Staph aureus (due to horizontal transmission from colonised visitors or health care workers)

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9
Q

What are the causes of late onset neonatal sepsis?

A

1) Staph aureus
2) Staph epidermis
3) E coli
4) Pseudomonas
5) Klebsiella
6) Strep pneumoniae

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10
Q

When are the initial investigations for neonatal sepsis?

A

1) Bloods - FBC, CRP and blood culture (before first dose of abx)
2) Strong consider LP - essential if suspect neonatal meningitis
3) CXR - only if strong suspicion of chest source
NICE advices against urine culture in early onset neonatal sepsis

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11
Q

When should CRP be repeated in neonatal sepsis?

A

24-36h after the initial dose of abx

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12
Q

How do you treat neonatal sepsis?

A

1) IV Benzylpenicillin + gentamicin (empirical treatment)
2) This is further adjusted based on culture results and the clinical picture
3) Gentamicin levels require monitoring

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13
Q

How can early onset neonatal sepsis with GBS infection present?

A

Respiratory distress (grunting, tachypnoea, nasal flaring, use of accessory muscles) + fever

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14
Q

What is the second most common pathogen for early-onset neonatal sepsis?

A

E coli

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15
Q

What are the clinical features of Listeria monocytogenes early-onset neonatal sepsis?

A

1) Accounts for ~5% in premature neonates
2) Rare in those > 35 weeks
3) Commonly transmitted by aspiration/swallowing of amniotic fluid or vaginal secretions form the mother or transplacentally
4) Pregnant women typically acquire listeria infection from contaminated foods such as contaminated meats, poultry, dairy products, and vegetables

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16
Q

What is transposition of the great arteries (TGA)?

A

Cyanotic congenital cardiac defect where the origins of the aorta and pulmonary artery are swapped

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17
Q

What causes transposition of the great arteries (TGA)?

A

1) In normal development, the aortopulmonary septum spirals
2) In TGA, this spiral doesn’t happen, which means that the aorta leaves the right ventricle and supplies the body while the pulmonary artery leaves the left ventricle and supplies the lungs
3) This in effect creates two parallel circulations and is not compatible with life without shunting via the ductus arteriosus and sometimes septal defects

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18
Q

What maternal condition is transposition of the great arteries (TGA) associated with?

A

Maternal type 1 or 2 diabetes

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19
Q

How is transposition of the great arteries (TGA) diagnosed?

A

1) Most diagnoses are made antenatally
2) Neonates may be diagnosed postnatally when they are cyanotic at birth or may become cyanotic upon closure of the ductus arteriosus

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20
Q

How is transposition of the great arteries managed?

A

1) Requires surgery within the first few months of life to correct the defect
2) Patients may be started on prostaglandin E infusions while they await surgery

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21
Q

How does transposition of the great arteries (TGA) present?

A

1) Cyanosis in first 24h of life
2) Struggling to breathe
3) Examination - central cyanosis, tachypnoea, loud single S2, low saturation

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22
Q

How does congenital diaphragmatic hernia present?

A

1) Severe cyanosis at birth
2) Bowel sounds in one hemithorax
3) Scaphoid abdomen
4) Heart sounds may also be auscultated on the right due to mediastinal shift

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23
Q

When are most cases of CDH diagnosed?

A

Antenatally

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24
Q

Is TGA more common in males or females?

A

Males

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25
Q

When does tetralogy of fallot present?

A

1-2 months of life

26
Q

How does tetralogy of fallot present?

A

1) Cyanosis
2) Auscultation - ejection systolic murmur at left sternal border secondary to pulmonary stenosis

27
Q

What is the most common cause of cyanotic congenital heart disease`/

A

Tetralogy of Fallot

28
Q

What is respiratory distress syndrome caused by?

A

Lack of surfactant in preterm neonates

29
Q

What is a risk factor for respiratory distress syndrome?

A

Gestational diabetes

30
Q

What medication is used in ADHD?

A

Methylphenidate

31
Q

Which is the most common congenital cardiac abnormality?

A

Ventricular septal defect (VSD)

32
Q

What is VSD?

A

When there is a hole in the septum that separates the ventricles of the heart

33
Q

How do VSDs present?

A

1) Small VSD - asymptomatic, pan-systolic murmur
2) Large VSD - SOB on exertion (e.g. breastfeeding), bc work of breathing is increased there might be poor weight gain, resulting in faltering growth
3) Undetected VSD - HF when heart decompensates

34
Q

How are VSDs diagnosed?

A

Echocardiogram (also grades severity)

35
Q

What might a CXR or ECG show in VSD?

A

Enlarged left ventricle

36
Q

How are VSDs managed?

A

1) The majority self-resolve so conservative management with increased caloric intake and observation with follow up
2) Large defects with don’t resolve or defects causing HF will require closure via a catheter intervention

37
Q

How do atrial septal defects present?

A

Asymptomatic, ejection systolic murmur + split S2

38
Q

What is truncus arteriosus?

A

When the septum that separates the aorta and pulmonary artery fails to form properly causing a right-to-left shunt

39
Q

How does truncus arteriosus present?

A

Early-onset cyanosis

40
Q

Which heart defects present with early-onset cyanosis?

A

1) Transposition of the great arteries/vessels
2) Truncus arteriosus

41
Q

What is Eisenmenger syndrome?

A

Reversal of direction of cardiac shunting - occurs in older children when a congenital left-to-right shunt (patent ductus arteriosus, ASD or VSD) reverses to a right-to-left shunt - acquired right-to-left shunt

42
Q

How does Eisenmenger syndrome present?

A

1) Late onset cyanosis - in late teens
2) May develop right heart failure
3) Pulmonary HTN and right ventricular hypertrophy
4) ± harsh holosystolic murmur loudest at the lower left sternal edge
5) Low O2 sats
6) Clubbing
7) SOB on exertion

43
Q

How does Turner’s syndrome present?

A

1) Short stature (most common feature)
2) Lymphoedema of hands and feet in neonate, may persist
3) Spoon-shaped nails
4) Webbed neck
5) Widely space nipples
6) Wide carrying angle
7) Congenital heart defects - bicuspid aortic valve (most common), coarctation of the aorta
8) Delayed puberty
9) Ovarian dysgenesis causing infertility
10) Hypothyroidism
11) Recurrent otitis media
12) Normal intellect

44
Q

Which cardiovascular conditions are patients with Turner syndrome at increased risk of?

A

1) Aortic stenosis - bc of the bicuspid aortic valve
2) Aortic dissection - bc of coarctation of the aorta

45
Q

What is the management of Turner’s syndrome?

A

1) Growth hormone therapy
2) Oestrogen replacement to allow development of secondary sexual characteristics

46
Q

What conditions is Turner’s syndrome associated with?

A

1) Congenital heart defects - bicuspid aortic valve (most common), coarctation of the aorta
2) Delayed puberty and ovarian dysgenesis causing infertility
3) Hypothyroidism
4) Recurrent otitis media

47
Q

What are the physical characteristics of Turner’s syndrome?

A

1) Short stature
2) Lymphoedema of hands and feet in neonate, may persist
3) Spoon-shaped nails
4) Webbed neck
5) Widely space nipples - broad chest
6) Wide carrying angle
7) High arched palate
8) Low-set ears
9) In-turned elbows
10) Short fingers
11) Ptosis or hooded eyes

48
Q

What are the four defects in tetralogy of fallot?

A

1) VSD
2) Aorta overriding the VSD
3) Pulmonary stenosis (right ventricular outflow tract obstruction)
4) Right ventricular hypertrophy

49
Q

Which is the most common cardiac defect in Down syndrome?

A

Atrioventricular septal defect

50
Q

What is atrioventricular septal defect?

A

Abnormal connection between the atria and ventricles either side of the heart

51
Q

How does atrioventricular septal defect present?

A

Cyanosis, HF and pulmonary HTN

52
Q

What condition is aortic dissection associated with?

A

Ehler-Danlos and Marfan syndrome (and turner’s bc of coarctation of the aorta)

53
Q

What condition are premature infants at high risk of developing with intensive 100% FiO2 supplemental oxygen therapy for long periods?

A

Retinopathy of prematurity

54
Q

What is the treatment for retinopathy of prematurity?

A

Retinal laser therapy

55
Q

What increases the risk of hypoxic damage in a premature infant?

A

1) Placental abruption - reduced blood flow from the placenta
2) Requiring resuscitation - the neonate did not breathe spontaneously at birth

56
Q

What causes Eisenmenger syndrome?

A

1) Increased pulmonary pressures cause changes in the pulmonary vasculature resulting in pulmonary hypertension
2) This results in the shunt reversing and is accompanied with right ventricular hypertrophy

57
Q

What is the prognosis of Eisenmenger syndrome?

A

Eisenmenger syndrome is a late phenomenon that is irreversible and generally progresses to severe cardiac failure, often fatal by around age 40

58
Q

How do you manage Eisenmenger syndrome?

A

1) Eisenmenger syndrome is best treated by prevention - i.e. identifying and promptly treating causes of left-to-right shunts
2) Otherwise, the treatment for Eisenmenger syndrome would be a heart-lung transplant, or palliation if this is not an option

59
Q

How does coarctation (narrowing) of the aorta present?

A

Generally asymptomatic but may present in later life with HF in severe cases

60
Q

What is total anomalous pulmonary venous return?

A

1) Abnormal insertion of the pulmonary veins
2) Rare cause of right-to-left shunting
3) Presents with cyanosis in infancy and requires surgical repair in infancy

61
Q

What are examples of left-to-right shunts that if left untreated could present as Eisenmenger syndrome later in teens?

A

1)Patent ductus arteriosus
2) ASD
3) VSD

62
Q

How does lead poisoning present?

A

1) Blue lines in the gums
2) Abdominal pain
3) Peripheral neuropathy
4) Microcytic anaemia

Stage 3 (61 decks)

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