paeds Flashcards
name 4 signs of respiratory distress in infants
head bobbing grunting nasal flaring use of accessory muscles tracheal tug tachypnoea cyanosis
most common cause of pneumonia in neonates
group B streptococcus
most common cause of pneumonia in older kids
s.pneumonia or h.influenza
how would you investigate suspected pneumonia in a child
capillary blood gas to look for T2 resp failure
septic screen
CXR
sputum culture
1st line treatment of pneumonia in neonates
broad spec!!
1st line treatment of pneumonia in older kids
amoxicillin, co-amox if suspected h.influenzae
clinical presentation of pneumonia in neonates
non specific hypoxia failure to thrive poor feeding grunting recessions fever
organism causing bronchiolitis
RSV
organism causing whooping cough
bordatella pertussis
organism causing croup
parainfluenza virus 1-3
differences between croup and whooping cough
no stridor in whooping cough
croup can cause stridor
croup is more acute whooping cough lasts for weeks
can get complications from severe coughing fits in whooping cough eg vomiting pneumothorax retinal haemorrhages
management of croup
po dexamethasone stat dose
supportive: o2 fluids ng feed
nebulised adrenaline or budenoside if severe distress
management of whooping cough
1st like azithromycin or clarithromycin
management of bronchiolitis
supportive
presentation of bronchiolitis
winter months toddler aged under 2 years cough coryza resp distress wheeze and inspiratory crackles
what should you always monitor when giving salbutamol for acute asthma
potassium levels (hypokalaemia)
how do you manage a strawberry naevus
topical propanolol
will regress in 3-6 months
widespread white pinpoin papules develop on neonate day 3 of life, what is the cause
erythema toxicum neonatorum
boggy superficial scalp swelling that crosses the suture lines on neonate, what is the diagnosis
capput succedanum
superficial scalp swelling confined within the suture lines on neonate
cephalohaematomab - a sub periosteal haemorrhage
can cause jaundice when the haematoma is broken down due to the haemolysis overwhelming the new born liver
when is jaundice classed as normal vs abnormal in neonates
always abnormal in 1st 24 hours of life
up to 2 weeks considered physiological
develops after 2 weeks can be either normal or abnormal
name 3 causes of jaundice in first 24 hours of life
rhesus haemolytic disease of newborn abo incompatibility TORCH infections hereditary spherocytosis g6pd deficiency
describe rhesus haemolytic disease of the newborn
jaundice in 1st 24 hours of life
where neonate is rhesus positive and mother is rhesus negative and blood mixes during birth trauma and causes mother to produce antibodies against fetal blood so causes haemolysis (pre hepatic so causes unconjugated bilirubin levels to be high)
describe ABO incompatibility in newborns
more common than rhesus disease
where mum is group O and baby is A or B
causes jaundice in 1st 24 hours of life due to haemolysis
diagnose by doing coombes test
name the TORCH infections
toxoplasmicosis other (parvovirus, varicella) rubella CMV herpes/hepatitis
how does congenital hypothyroidism present
macroglossia (bc thyroid descends from the tongue in embryology) failure to thrive hypotonia prolonged jaundice umbilical hernia pale mottled skin hoarse cry puffy face
3 day old has hypotonia, puffy face, hoarse cry, jaundice and macroglossia what is it
congenital hypothyroidism
how do you manage congenital hypothyroidism
thyroxine replacement must be started within the 1st 2 weeks of life to avoid irreversible cognitive impairment (low TSH stunts growth)
what is the most common cause of congenital hypothyroidism
failure to thyroid to migrate or iodine deficiency globally
what is digeorge sydrome
congenital hypoparathyroidism
thymic aplasia causes a lowered immune system
cardiac defects
what is the pathophysiology behind congenital adrenal hyperplasia
21 hydroxylase deficiency means the adrenals cant produce cortisol or aldosterone (basically congenital addisons), meaning the pituitary over produces ACTH to try and stimulate the adrenals, but this causes excess testosterone to be produced (bc produced by the adrenals but doesnt require 21 hydroxylase) meaning the baby will get symptoms of excess testosterone and salt losing
symptoms of congenital adrenal hyperplasia
within 1st 3 weeks of life…
- vomiting, weight loss, hypotonia, circulatory collapse = hyponatraemia, hyperkalaemia and metabolic acidosis due to low aldosterone
note: doesn’t present immediately after birth bc babies still have some steroid hormones left from placenta from mum
older children:
- clitoral hypertrophy
- fusion of the labia
- enlarged penis with dark coloured scrotum
tall, muscular, adult body odour, precoicious pubarche, acne
how do you manage congenital adrenal hyperplasia
- IV fluid resus with sodium replacement
- glucose
- hydrocortisone acutely and life long to suppress excess ACTH
- can use fludrocortisone to boost bp in severe cases
what do you screen for in new born babies (exam and tests)
Developmental dysplasia hip - ortholini and bartlow test congenital heart disease congenital cataracts (red reflex) undescended testes newborn hearing - otoacoustic emission testing (if this is abnormal then do auditory brainstem response testing) Guthrie heel prick test: CF congenital hypothyroid sicklecell/thalassamemia 6 x inherited metabolic disorders
what is hypoxic ischaemic encephalopathy and what is the complication of it
perinatal asphyxia during birth either due to placental or pulmonary issues
causes cerebral palsy or death
name 5 causes of hypoxic ischaemic encephalopathy
cord compression/prolapse prolonged uterine contractions placental or uterine abruption maternal hypotension intrauterine growth restriction
how does hypoxic ischaemic encephalopathy present
presents immediately with.. irritable infant abnormal movements hypo or hyper tonia seizures cant feed hyperventilation / impaired brething multi organ failure
how do you manage a baby with hypoxic ischaemic encephalopathy
immediate resus to reduce neuronal damage
rescue breaths and ventilation
anti convulsants
inotropes for hypotension
correct electrolytes and fluid imbalance
wrap baby in a cooling blanket after birth (therapeutic hypothermia)
EEG monitors can be useful to identify HIE
how do you differentiate between caput seccedaneum and cephalohaematoma
caput succedaneum extends beyond the skull sutures and often resolves in a couple of days, is only made of bruising and oedema
cephalohaematoma is bleeding below the periosteum so is confined within skull sutures, feels soft and usually resolves in a few weeks but can cause jaundice from haemolysis of the haematoma
what is a subaponeurotic haemorrhage
a birth injury that causes diffuse boggy swelling of the entire scalp and can causes severe blood loss and shock
what is erbs palsy
damage to C6 and c5 after a breech or shoulder delivery
refer child at 2-3 months if not resolved
which babies are more prone to respiratory distress syndrome
pre term babies and babies of diabetic mothers
what is respiratory distress syndrome caused by
a deficiency of surfactant in the lungs in prem babies means lungs cant maintain adequate surface tension meaning alveoli collapse causing reduced gas exchange
almost always in babies less than 28 weeks
why are steroids given to pre term babies
to develop the lungs to avoid respiratory distress syndrome and bronchopulmonary dysplasia
also decreases risk of intraventricular haemorrhage
how does respiratory distress syndrome present
resp distress (tachypnoea, increased WOB, recessions, grunting, nasal flaring, cyanosis) within 4 hours of birth or at delivery
how do you manage respiratory distress syndrome
give surfactant via tracheal tube
CPAP / high flow o2 via nasal cannula
how should neonates be ventilated
at lowest effective pressures to avoid pneumothorax
what is bronchopulmonary dysplasia and what causes it
occurs in babies who have had respiratory distress syndrome (surfactant deficiency) at birth and still have an oxygen requirement at 28 days post birth = classed as bronchopulmonary dysplasia
how do you manage bronchopulmonary dysplasia
CPAP - dont over oxygenate tho
steroids
caffeine!!
what is apnoea of prematurity and how do you treat it
spontaneous stopping breathing and desaturations
managed with IV caffeine and tactile stimulation when apnea monitor goes off
what is transient tachypnoea of the newborn and how can you differentiate it from respiratory distress syndrome
RDS = prem babies
TTN = TERM BABIES
more common following C-sections
caused by delayed fluid resorption in the lungs, may see fluid in the horizontal fissure on CXR
presents with signs of resp distress
often self resolving within 48 hours but can use o2 and cpap if needed
what is meconium aspiration syndrome, who is it more common in and how do you manage it
where meconium is released due to fetal hypoxia/distress and is aspirated in the lungs = causes hyperinflation and obstruction and a chemical pneumonitis so more prone to infection.
more common with increasing gestational age so uncommon in prem babies
treated with suctioning and ventilation
name 3 causes of persistent pulmonary hypertension of the newborn
birth asphyxia
meconium aspiration
sepsis
RDS
how does persistent pulmonary hypertension of the newborn present
cyanosis immediately after birth due to a right to left shunt in the lungs, without murmurs or any other signs of heart failure
but still need to do echo to exclude CHD
how do you manage persistent pulmonary hypertension of the newborn
- ventilation
- inhaled nitric oxide or slidenafil to vasodilate pulmonary vessels
- if severe can place newborn on a heart and lung bypass machine (extracorpeal membrane oxygenation)
what 3 things are seen on abdo xray in necrotising enterocolitis
- dilated loops of bowel
- bowel wall oedema
- pneumonitis intestinalis (intramural gas)
how does nectrotising entercolitis present
in 1st few weeks of life billious vomiting, poor feeding, failure to thrive then.. fresh blood in stool abdo distension shock
what is riglers sign
air inside and outside the bowel
how do you manage necrotising enterocolitis
stop feeds broad spec abx mechanical ventilation parentral nutrition surgery to correct perforation
what complication does coarctation of the aorta increase your risk of
cerebral aneurysms
how does biliary atresia present
prolonged jaundice over 14 days palpable liver pale stools dark urine conjugated bilirubin and raised alp and ast bc obstructive jaundice
how is billiary atresia diagnosed
cholangiography shows absence of billiary tree
liver uss shows fibrotic changes
causes of billous vomit in kids
intestinal obstruction (volvulus) duodenal atresia
management of pyloric stenosis
abcde
fluids and electolyte replacement
intubate / ng feed
ramsteds pylorotomy
diagnosis and management of suspected volvulus
upper gi contrast and USS
surgical emergency to save bowel (ischaemia if superior mesenteric artery compressed)
laparotomy to untwist bowel
or lads procedure if bowel remains healthy
what is intususseption and when does it happen
invagination / telescoping of proximal bowel into distal bowel
neonates or aged 2/3
what causes intususseption
peyers patch enlargement
meckel diverticulum
colicky abdo pain in neonate, child goes pale and pulls legs up to abdo, gen unwell, been vomiting, red currant jelly stool in rectum, sausage shaped mass in abdo, hypovolaemic shocked
what is diagnosis and how do you diagnose
intusseption
USS abdomen shows donut sign
how do you manage intususseption
if no complications do radiological insufflation
if shocked fluid resus and surgery
what is meckels diverticulum, what are the symptoms and how do you diagnose
embryological remenent of intesinal duct
can cause severe rectal bleeding
diagnose with techtenium scan
treat with surgery to resect it
what is duodenal atresia, what condition is it associated with, how does it present and what is the management
where duodenum not formed properly so not connected to rest of the bowel
downs syndrome
CP: not tolerating feeds, billous vomiting, abdo distension, delayed/failed to pass meconium
management: surgery to connect the bowel
