PAEDS - CARDIO, RESP, GI AND NEONATAL Flashcards
VSD
What are some complications of VSD?
- Increased risk of infective endocarditis > Abx prophylaxis during surgery
- AR, Eisenmenger’s syndrome + right heart failure
COARCTATION OF AORTA
What is the clinical presentation of coarctation of aorta?
How may it present if severe?
- Weak femoral pulses + radiofemoral delay
- Systolic murmur between scapulas or below L clavicle
- Heart failure, tachypnoea, poor feeding, floppy
- LV heave (LVH)
- Acute circulatory collapse at 2d as duct closes (duct dependent)
RHEUMATIC FEVER
What are the major criteria in rheumatic fever?
JONES –
- Joint arthritis (migratory as affects different joints at different times)
- Organ inflammation (pancarditis > pericardial friction rub)
- Nodules (subcut over extensor surfaces)
- Erythema marginatum rash (pink rings of varying sizes on torso + proximal limbs)
- Sydenham chorea
RHEUMATIC FEVER
What are the minor criteria in rheumatic fever?
FEAR –
- Fever
- ECG changes (prolonged PR interval) without carditis
- Arthralgia without arthritis
- Raised CRP/ESR
SUPRAVENTRICLAR TACHYCARDIA
What is the management of a supraventricular tachycardia?
- 1st line = Vagal stimulation (carotid sinus massage, cold ice pack to face)
- 2nd line = IV adenosine
- 3rd line = Electrical cardioversion
- Long term = ablation of pathway or flecainide
TOF
What are some risk factors?
- Rubella,
- maternal age >40,
- alcohol in pregnancy,
- maternal DM
SUPRAVENTRICLAR TACHYCARDIA
What is the ECG like?
- Narrow complex tachycardia (250-300bpm)
- WPW = delta wave (slurred upstroke to QRS) with a short PR interval
RESP OVERVIEW
What are some risk factors for respiratory infections?
- Parental smoking
- Poor socioeconomic status
- Male gender
- Immunodeficiency
- Underlying lung disease
BRONCHIOLITIS
What are some criteria for admission?
- Apnoea
- Severe resp distress (RR>60, marked chest recession, grunting)
- Central cyanosis
- SpO2 < 92%
- Dehydration
- 50–75% usual intake
BRONCHIOLITIS
What can be given as prevention against bronchiolitis?
Who would be given this?
- Monoclonal Ab to RSV = palivizumab as monthly IM
- Reduces hospital admissions in high-risk infants (preterm, cystic fibrosis, congenital heart disease)
PNEUMONIA
How can CXR indicate what the causative organism may be?
- Lobar consolidation (dense white area in a lobe) = pneumococcus
- Rounded air-filled cavities (pneumatoceles) + multi-lobar = S. aureus
PNEUMONIA
What is the management of pneumonia?
- Newborns = IV benzylpenicillin
- Older = co-amoxiclav
- erythromycin to cover for mycoplasma, chlamydia or if unresponsive
ASTHMA
What are the characteristics of asthma?
- Airflow limitation due to bronchospasm (reversible spontaneously or with Tx)
- Airway hyperresponsiveness to various triggers
- Bronchial inflammation
ASTHMA
What is classed as a severe asthma exacerbation?
- PEFR 33–50% predicted
- Unable to complete full sentences
- RR>50 (2-5y), or >30 (>5y)
- HR >130 (2-5y) or >120 (>5y)
- Signs of resp distress (chest recessions)
- SpO2 <92%
CYSTIC FIBROSIS
What is the pathophysiology of cystic fibrosis?
- Decreased Cl- excretion into airway lumen + increased reabsorption of Na+ into epithelial cells means less excretion of salt (+ so water) > increased viscosity of airway secretion
CYSTIC FIBROSIS
How does cystic fibrosis present in older children + adolescents?
- DM (pancreatic insufficiency)
- Cirrhosis + portal HTN
- Distal intestinal obstruction
- Pneumothorax or recurrent haemoptysis
- Sterility in males as absent vas deferens
CYSTIC FIBROSIS
What are some signs of cystic fibrosis?
- Low weight or height on growth charts
- Hyperinflation due to air trapping
- Coarse inspiration crepitations ± expiratory wheeze
- Finger clubbing
CYSTIC FIBROSIS
What are some typical causes of respiratory tract infections in cystic fibrosis?
- S. aureus
- H. influenzae
- Pseudomonas aeruginosa
- Bulkholderia cepacia associated with increased morbidity + mortality
ASTHMA
What are some risk factors for asthma?
LBW, FHx, bottle fed, atopy, male, pollution
VIRAL INDUCED WHEEZE
What are some risk factors?
Maternal smoking during/after pregnancy + prematurity
ASTHMA
What is the mechanism of action for theophyllines?
Relaxes bronchial smooth muscle + reduces inflammation
ASTHMA
What are the important side effects of ICS?
Oral thrush,
adrenal + growth suppression,
DM,
osteoporosis
ASTHMA
What are the important side effects of theophylline?
Vomiting,
insomnia,
headaches
PNEUMONIA
What are the common causes of pneumonia in infants + young children?
RSV most common,
pneumococcus #1 bacterial,
H. influenzae,
Bordatella pertussis,
chlamydia trachomatis
(S. aureus rarely but = serious)
PNEUMONIA
What are the common causes of pneumonia in children >5?
Pneumococcus,
mycoplasma pneumoniae,
chlamydia pneumoniae
MALABSORPTION
What are some causes of malabsorption?
- Small intestine disease = coeliac
- Exocrine pancreas dysfunction = CF
- Cholestatic liver disease, biliary atresia
- Short bowel syndrome (NEC, bowel removal)
- Loss of terminal ileum function (resection, Crohn’s, absent bile acid)
IBD
How do you induce remission in Ulcerative colitis?
Mild to moderate disease
- 1st line = aminosalicylate (e.g. mesalazine oral or rectal)
- 2nd line = corticosteroids (e.g. prednisolone)
Severe disease
- 1st line = IV corticosteroids (e.g. hydrocortisone)
- 2nd line = IV ciclosporin
IBD
How do you maintain remission in Ulcerative colitis?
What should be cautioned?
- PO/PR mesalazine, azathioprine or mercaptopurine
- Mesalazine can cause acute pancreatitis
COELIAC DISEASE
What is the consequence of the autoimmune response in coeliac disease?
- Autoantibodies in response to gluten exposure target epithelial cells of intestine > inflammation + atrophy of the intestinal villi > malabsorption of nutrients
COELIAC DISEASE
What are some complications of coeliac disease?
- Anaemias
- Osteoporosis
- Lymphoma (EATL)
- Hyposplenism
- Lactose intolerance
PYLORIC STENOSIS
What is the management of pyloric stenosis?
- Correct fluid + electrolyte disturbances (0.45% saline, 5% dextrose + K+ supplements) before any surgery
- Laparoscopic Ramstedt’s pyloromyotomy
APPENDICITIS
What are the signs of appendicitis?
- Low grade fever
- Abdominal pain aggravated by movement
- RIF tenderness + guarding (McBurney’s point)
- Rebound + percussion tenderness (precipitated by cough, jump)
- Rovsing’s sign = LIF pressure causes RIF pain
MECKEL’S DIVERTICULUM
What is Meckel’s diverticulum?
- Ileal remnant of the vitello-intestinal duct which contains ectopic gastric mucosa or pancreatic tissue
CONSTIPATION
What are some causes of constipation?
- Usually idiopathic
- Meds (opiates)
- LDs
- Hypothyroidism
- Hypercalcaemia
- Poor diet (dehydration, low fibre)
- Occasionally forceful potty training
CONSTIPATION
What are some red flags in constipation?
- Delayed passage of meconium = Hirschsprung’s, CF
- Failure to thrive = hypothyroid, coeliac
- Abnormal lower limb neurology = lumbosacral pathology
- Perianal bruising or multiple fissures = ?abuse
CONSTIPATION
What is the process of constipation and overflow diarrhoea?
- Prolonged faecal status = resorption of fluids = increase in size + consistency
- This leads to rectal stretching + reduced sensation > overflow + soiling (very smelly)
GORD
What are the investigations for GORD?
- Usually clinical but if atypical Hx, complications or failed Tx…
– 24h oesophageal pH monitoring
– Endoscopy + biopsy to identify oesophagitis
– Contrast studies like barium meal
GORD
What are some complications of GORD?
- Failure to thrive from severe vomiting
- Oesophagitis = haematemesis, discomfort on feeding or heartburn, Fe anaemia
- Aspiration > recurrent pneumonia, cough/wheeze
- Sandifer syndrome = dystonic neck posturing (torticollis)
GASTROENTERITIS
What are signs of clinical shock?
- Pale/mottled
- Hypotension
- Prolonged CRT
- Cold
- Decreased GCS
- Sunken fontanelle
- Weak pulses
- Anuria
GASTROENTERITIS
What are some complications of gastroenteritis?
- Isonatraemic + hyponatraemic dehydration
- Hypernatraemic dehydration
- Post-infective lactose intolerance (remove lactose + slowly reintroduce)
- Guillain-Barré
- Dehydration #1 cause of death
BILIARY ATRESIA
What are the investigations for biliary atresia?
- Serum split bilirubin = conjugated elevated
- USS abdo gold standard for Dx, laparotomy confirms
BILIARY ATRESIA
What is the management of biliary atresia?
- Kasai portoenterostomy (attach section of small intestine to opening of liver where bile duct attaches)
- Some will need full liver transplant
- Success decreases with age so early Dx crucial
NEONATAL HEPATITIS
What are some investigations for neonatal hepatitis syndrome?
- Deranged LFTs with raised unconjugated + conjugated bilirubin
- Liver biopsy = multinucleated giant cells + Rosette formation
NEONATAL HEPATITIS
What are 4 main causes of neonatal hepatitis?
- Congenital infection
- Alpha-1-antitrypsin (A1AT) deficiency
- Galactosaemia
- Wilson’s disease
NEONATAL HEPATITIS
What are the complications of galactosaemia?
- Rapidly fatal course with shock, DIC + haemorrhage due to gram -ve sepsis
- Liver failure, cataracts + Developmental delay if untreated
NEONATAL HEPATITIS
What is the management of galactosaemia?
- Stop cow’s milk, breastfeeding C/I
- Dairy-free diet
- IV fluids
NEONATAL HEPATITIS
What is Wilson’s disease?
- Reduced synthesis of caeruloplasmin (normally binds to copper + allows it to be excreted with bile)
NEONATAL HEPATITIS
How does Wilson’s disease present?
Sx of copper accumulation
- Eyes (Kayser-Fleischer rings)
- Brain (Parkinsonism + psychosis)
- Kidneys (vit D resistant rickets)
- Liver (jaundice)
NEONATAL HEPATITIS
What are the investigations for Wilson’s disease?
- 24h urine copper assay (high),
- serum caeruloplasmin (low)
FAILURE TO THRIVE
What are some causes of malabsorption?
- Cystic fibrosis
- Cow’s milk protein intolerance
- Coeliac disease
- IBD
- Short gut syndrome
CMPA
What is the management for cows milk protein allergy (CMPA)?
- Breastfeeding mothers should avoid dairy
- Replace formula with extensive hydrolysed formula
- Amino acid-based formula if severe or no response to eHF
- Food challenge may be performed in hospital setting
KWASHIOKOR
what are the clinical features?
- growth retardation
- diarrhoea
- anorexia
- oedema - defining characteristic
- skin/hair depigmentation
- abdominal distension with fatty liver
MARASMUS
what are the clinical features?
- height is relatively preserved compared to weight
- wasted appearance
- muscle atrophy
- listless
- diarrhoea
- constipation
HERNIA
what are the risk factors for developing a hernia?
- premature, underweight babies
- male gender
- family history
- medical conditions - undescended testes, CF
- African descent
CHOLEDOCHAL CYST
what are the investigations?
can be detected on ultrasound before the child is born
after the baby is born, the parent’s may notice lump in RUQ, the following tests are then done:
- CT scan
- cholangiography
LIVER FAILURE
what are the causes?
- chronic hepatitis
- biliary tree disease
- toxin induced
- A1AT deficiency
- autoimmune hepatitis
- wilson’s disease
- CF
- budd-chiari syndrome
- primary sclerosing cholangitis
IBD
what is the histology of ulcerative colitis?
- Increased crypt abscesses,
- pseudopolyps,
- ulcers
COELIAC DISEASE
What is the pathophysiology?
Autoimmune response to alpha-gliadin portion of protein gluten causes inflammation in small intestine (particularly jejunum)
COELIAC DISEASE
What conditions is coeliac disease associated with?
- T1DM,
- thyroid,
- Down’s syndrome,
- FHx = test for it
GASTROENTERITIS
How is shock managed in gastroenteritis?
Rapid IVI (0.9% NaCl 20ml/kg), repeat if necessary, Abx if septicaemia
BILIARY ATRESIA
What genetic mutation is biliary atresia associated with?
Associated with CFC1 gene mutations
NEONATAL HEPATITIS
What is the presentation of A1AT deficiency?
- Prolonged neonatal jaundice (cholestasis), worse on breast feeding,
- can have (prolonged) bleeding due to vitamin K deficiency,
- COPD
NEONATAL HEPATITIS
What are the genetics for Wilson’s disease?
AR on chromosome 13
FAILURE TO THRIVE
What are some causes of inability to process nutrients properly?
- T1DM,
- inborn errors of metabolism
NEONATAL HEPATITIS
What is the management of Wilson’s disease?
Penicillamine for copper chelation
ASTHMA
What is the stepwise management of chronic asthma in <5y? (BTS guidance)
- 1 = PRN SABA
- 2 = Low dose ICS OR PO montelukast
- 3 = Other option from 2
- 4 = refer to specialist
ASTHMA
What is the stepwise management of chronic asthma >5y? (BTS guidance)
- 1 = PRN SABA
- 2 = SABA + low dose ICS
- 3 = SABA + low dose ICS + LABA (only continue if good response)
- 4 = increase ICS dose (?LTRA or PO theophylline)
- 5 = PO steroids in lowest tolerated dose
- May need immunosuppression or immunomodulation therapy with specialist referral
ASTHMA
What is the management of asthma in <5 year olds (NICE guidance)
- PRN SABA
- SABA + 8 week trial of moderate ICS
- SABA + low ICS + LTRA
- Stop LTRA and refer to specialist
ASTHMA
What is the management for children >5yrs old? (NICE guidance)
- SABA
- SABA + low dose ICS
- SABA + low dose ICS + LTRA
- SABA + low dose ICS + LABA
- SABA + MART (including low dose ICS)
- SABA + MART (including mod dose ICS) / LABA + moderate dose ICS
- SABA + high dose ICS / theothylline + refer to specialist
ASTHMA
What are the stages of management for acute asthma of moderate severity in children?
Moderate: Inhaled SABA 10 puffs, PO prednisolone, reassess in 1h
ASTHMA
What are the stages of management for acute asthma of severe/life-threatening severity in children?
- High flow O2 if sats <92%
- Salbutamol inhaler (10 puffs every 2 hours)
- nebuliser with salbutamol and ipratropium bromide
- IV hydrocortisone
- IV Magnesium sulfate
- IV salbutamol
- IV aminophylline
RESP PHARMACOLOGY
Give an example of a SABA
Salbutamol
RESP PHARMACOLOGY
Give an example of a SAMA
Ipratropium Bromide
RESP PHARMACOLOGY
Give an example of a LABA
Salmeterol
RESP PHARMACOLOGY
Give an example of a LAMA
tiotropium
RESP PHARMACOLOGY
Give an example of an LTRA?
montelukast
RESP PHARMACOLOGY
Give an example of an ICS
Beclometasone
CHILD ABUSE
What are some risk factors for child abuse?
- Child = failure to meet expectations (disabled, wrong sex), born after forced or commercial sex work
- Parent = MH issues, substance abuse, LD, young
- Family = stepparents, domestic abuse, multiple or closely spaced births
- Environment = low socioeconomic status
CHILD ABUSE
What features in the history are suspicious for child abuse?
- Too many injuries, wrong site, unusual shape or pattern
- Delay in presenting (old injuries), multiple A&E visits
- No Hx, Hx inconsistent with injuries or that changes
CHILD ABUSE
Where are normal and abnormal places for a child to bruise?
- Shins, knees, elbows, toddlers can bump their heads
- Abdo, genitalia, insides of arms/legs, behind neck or other soft bits, young babies that cannot roll
CHILD ABUSE
What other features may raise alarms for child abuse?
- # = metaphyseal, multiple # at different healing stages, posterior rib # in babies v. specific, radial, humeral, femoral
- Bruising, burns, scalds, failure to thrive
- Torn frenulum (forcing bottle into mouth)
CHILD ABUSE
What is the management for suspected child abuse?
- FBC, clotting screen, bone profile, radiology
- Developmental + social services assessment
- If suspected > hospital admission + can break confidentiality
- Fundoscopy for retinal haemorrhages
CHILD ABUSE
What law is relevant to child abuse?
- Child act 2004 allows to speak to child without parents’ consent, safeguards children
FAS
How much alcohol is safe in pregnancy?
What are some features of foetal alcohol syndrome?
- None
- Microcephaly
- Short palpebral fissures, hypoplastic upper lip, small eyes, smooth philtrum
- LDs, poor growth + cardiac malformations
- Can have alcohol withdrawal Sx a birth = irritable, hypotonic, tremors
SWELLINGS + CYSTS
What is mastoiditis?
How does it present?
Management?
- Med emergency as can cause meningitis, sinus thrombosis
- External ear may protrude forwards, severe otalgia (classically behind), fever
- Swelling, erythema + tenderness over mastoid process
- Abx ±mastoidectomy
PAEDS FLUIDS
What are 3 essential components to a safe fluid prescription?
- Fluid constituents + bag size = NaCl 0.9% + dextrose 5% + KCl 10mmol (500ml)
- Rate of administration in ml/hour
- Signature
PAEDS FLUIDS
What are important things to consider prior to prescribing fluids?
- Weight ([Age + 4] x 2), including weight change
- Fluid input/output in past 24h
- Fluid status (dehydrated)
- Recent bloods (electrolytes)
PAEDS FLUIDS
What is used for maintenance fluids?
How are they calculated?
- 0.9% NaCl + 5% dextrose + KCl 10mmol
- 100ml/kg/day for first 10kg
- 50ml/kg/day for next 10kg
- 20ml/kg/day for every kg after 20kg
- Divide by 24 = ml/hour
PAEDS FLUIDS
How can you calculate % dehydration?
How do you calculate fluids to correct dehydration?
- (Well weight [kg] – current weight [kg]) ÷ well weight
- % dehydration x 10 x weight (kg)
PAEDS FLUIDS
What is the general rule for fluid boluses?
- Given in shock
- 0.9% NaCl at 20ml/kg over <10m
- After >3 boluses call for paeds intensive care support as risk > pulmonary oedema
PAEDS FLUIDS
What fluids do neonates require?
What are their intake requirements?
- Day 1 = just 10% dextrose
- From day 2 = Na (3mmol/kg/day) + K (2mmol/kg/day)
- Day 1 = 60ml/kg/day
- Day 2 = 90ml/kg/day
- Day 3 = 120ml/kg/day
- Day 4 + beyond = 150ml/kg/day
DEVELOPMENTAL STAGES
How do the developmental milestones correspond with prematurity?
- Age correct up to 2 years
- 9m born 2 months early should only be expected to be at developmental stage of 7m
DEVELOPMENTAL STAGES
In terms of gross motor development, what would you expect for a new born?
New born = Limbs flexed, symmetrical posture, head lag on pulling up
DEVELOPMENTAL DELAY
What are some prenatal causes of developmental delay?
- Genetics (Down’s, fragile X)
- Congenital hypothyroidism
- Teratogens (alcohol + drug abuse)
- Congenital infection (TORCH)
- Neurocutaneous syndromes (tuberous sclerosis, neurofibromatosis)
DEVELOPMENTAL DELAY
What are some perinatal causes of developmental delay?
- Extreme prematurity (intraventricular haemorrhage)
- Birth asphyxia (HIE)
- Hyperbilirubinaemia
- Hypoglycaemia
DEVELOPMENTAL DELAY
What are some postnatal causes of developmental delay?
- Infection (meningitis, encephalitis)
- Anoxia (suffocation, near-drowning, seizures)
- Head trauma (accidental or NAI)
- Hypoglycaemia
DEVELOPMENTAL DELAY
What are some risk factors for developmental delay?
- Bio = prems, LBW, birth asphyxia, hearing/vision impairment
- Environment = poverty, poor parental education, maternal substance abuse
MEASUREMENT
How might the accuracy of measurements be compromised?
A part of measurement is working out the mid-parent height.
How is this done for boys and girls?
- Faulty technique (inexperienced staff), faulty equipment (wrongly calibrated), uncooperative child
- Boys = [(Dad + mum height in cm) ÷ 2] + 7
- Girls = [(Dad + mum height in cm) ÷ 2] – 7
CHILD ABUSE
what are the features of shaken baby syndrome
Retinal haemorrhages
Encephalopathy
Subdural haemotoma
PAEDIATRIC LIFE SUPPORT
If breathing stimulation fails what is the next stage of neonatal resuscitation?
Inflation breaths if gasping or not breathing –
- 2 cycles of 5 inflation breaths
- No response + HR low = 30s of ventilation breaths
- No response, HR <60bpm = chest compressions (3:1 with ventilation breaths)
RDS
What are some risk factors of RDS?
- Prematurity #1
- Maternal DM
- 2nd premature twin
- C-section
NEC. ENTEROCOLITIS
What are some risk factors for necrotising enterocolitis?
- Very LBW + premature
- Formula feeds (breast milk protective)
- RDS + assisted ventilation
- Sepsis
- PDA + other CHD
NEC. ENTEROCOLITIS
What are some investigations for necrotising enterocolitis?
- Blood culture (sepsis)
- CRP
- Capillary blood gas = metabolic acidosis
- AXR is diagnostic
NEC. ENTEROCOLITIS
What would an AXR show in necrotising enterocolitis?
- Dilated loops of bowel
- Bowel wall oedema (thickened bowel walls)
- Pneumatosis intestinalis (intramural gas)
- Pneumoperitoneum (free gas in peritoneum = perf)
- Football sign = air outlining falciform ligament
- Rigler’s sign = air both inside/outside bowel wall
- Gas in portal veins
JAUNDICE
What are some risk factors for jaundice?
- LBW
- Breastfeeding
- Prematurity
- FHx
- Maternal diabetes
JAUNDICE
What are some causes of jaundice 24h–2w after birth?
- Physiological + breast milk jaundice (common)
- Infection (UTI, sepsis)
- Haemolysis, polycythaemia, bruising
- Crigler-Najjar syndrome (rare inherited disorder with no UGT enzyme)
JAUNDICE
What are some causes of jaundice >2w after birth?
- Unconjugated = physiological or breast milk, UTI, hypothyroid, high GI obstruction (pyloric stenosis), Gilbert syndrome
- Conjugated (>25umol/L) = bile duct obstruction (biliary atresia), neonatal hepatitis
JAUNDICE
What is Gilbert’s syndrome?
How does it present?
- AR deficiency of UDP-glucuronyltransferase = defective bilirubin conjugation
- Unconjugated hyperbilirubinaemia (not in urine), jaundice may only be present if ill, exercising or fasting
JAUNDICE
What investigations would you perform in neonatal jaundice?
- FBC + blood film (polycythaemia, G6PD, spherocytosis)
- Bilirubin levels
- Blood type testing of mother + baby for ABO/Rh incompatibility
- Direct Coombs (antiglobulin) test for haemolysis
- TFTs, LFTs + urine MC&S
JAUNDICE
What increases the risk of kernicterus?
- Prematurity as immature liver
HIE
What happens as a result of cardiorespiratory depression?
- Hypoxia, hypercarbia + metabolic acidosis
- Compromised cardiac output reduces tissue perfusion > hypoxic ischaemic injury to brain
HIE
What is used to stage the severity of HIE?
What are the stages?
Sarnat staging –
- Mild = poor feeding, generally irritable + hyperalert, resolves in 24h
- Moderate = poor feeding, lethargic, hypotonic, seizures, can take weeks to resolve
- Severe = reduced GCS, apnoeas, flaccid + reduced/absent reflexes, half die
TORCH
What are the characteristic features of toxoplasmosis?
- Cerebral calcification, chorioretinitis + hydrocephalus
TORCH
What is the clinical presentation of CMV?
- 90% normal at birth
- 5% = hepatosplenomegaly, petechiae at birth, growth issues, neurodevelopmental disabilities (cerebral palsy, epilepsy, microcephaly)
- 5% = problems later in life, mainly sensorineural hearing loss
TORCH
How does herpes simplex virus present?
- Herpetic lesions on skin or eye, encephalitis or disseminated disease
TORCH
How does syphilis present?
- Rash on soles of feet + hands
- Hutchinson’s triad = keratitis, deafness, small + pointed teeth
MECONIUM ASPIRATION
What are some risk factors for meconium aspiration?
- Post-term deliveries at 42w
- Maternal HTN or pre-eclampsia
- Smoking or substance abuse
- Chorioamnionitis
MECONIUM ASPIRATION
What investigation would you do in meconium aspiration?
- CXR = hyperinflation, accompanied by patches of collapse + consolidation
- High incidence of air leak > pneumothorax
CLEFT LIP AND PALATE
What is the management of cleft lip + palate?
- MDT = plastic + ENT surgeons, paeds, orthodontist, SALT
- Cleft lip repair ≤3m
- Cleft palate repair 6-12m
BRONCHOPULMONARY DYSPLASIA
What investigations would you do for bronchopulmonary dysplasia?
- CXR = widespread areas of opacification, cystic changes, fibrosis
- Formal sleep study to assess SpO2 during sleep supports Dx + guides Mx
BRONCHOPULMONARY DYSPLASIA
How can bronchopulmonary dysplasia be prevented?
- Corticosteroids to mothers in premature labour <34w
- CPAP rather than intubation where possible
- Use caffeine to stimulate resp effort
- Do not over oxygenate
BRONCHOPULMONARY DYSPLASIA
What is the management of bronchopulmonary dysplasia?
- Some babies go home with low dose oxygen, weaned over first year
- Monthly IM palivizumab for RSV (+ bronchiolitis) protection
GROUP B STREP INFECTION
what are the possible complications in newborns?
- meningitis
- pneumonia
- sepsis
PREMATURITY
What are some metabolic complications of prematurity?
- Hypoglycaemia,
- hypocalcaemia,
- electrolyte imbalance,
- fluid imbalance
- hypothermia
JAUNDICE
How does kernicterus present?
What are the outcomes?
- Lethargy, poor feeding > hypertonia, seizures + coma
- Permanent damage = dyskinetic cerebral palsy, LD + deafness
NEONATAL HYPOGLYCAEMIA
What are some risk factors for neonatal hypoglycaemia?
- Preterm + intrauterine growth restriction (IUGR) = lack of glycogen stores
- Maternal DM = infantile hyperinsulinaemia
- LGA, polycythaemia or ill
- Transient hypoglycaemia common in first hours after birth
TORCH
How is syphillis managed?
- If fully treated ≥1m before delivery = no treatment
- Any doubts = benzylpenicillin
CLEFT LIP AND PALATE
What causes cleft lip?
Failure of fusion of the frontonasal + maxillary processes
CLEFT LIP AND PALATE
What causes cleft palate?
Failure of the palatine processes + nasal septum to fuse
OESOPHAGEAL ATRESIA
What is it associated with?
- Tracheo-oesophageal fistula + polyhydramnios
LISTERIA INFECTION
what is the clinical presentation?
symptoms are similar to sepsis - listlessness, irritable, poor feeding
- Early onset = low birth weight, obstetric complications, evidence of sepsis soon after birth
- late onset = usually full-term, previously healthy neonates, present with meningitis/sepsis
LISTERIA INFECTION
what is the management?
ampicillin + aminoglycoside (gentamycin)
