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NP- Phase 3a Medicine > Paeds- Neonatal Medicine > Flashcards

Paeds- Neonatal Medicine Flashcards

1
Q

Define failure to thrive

A

failure to gain adequate weight or achieve adequate growth at the normal rate for age

at least 2 growth measurements 3-6 months apart showing the child falls across centile lines

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2
Q

what is the most common cause for failure to thrive?

A

inadequate calorie intake

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3
Q

give some organic causes that could lead to a child failing to thrive

A
  • impaired suck/ swallow- motor dysfunction, neuro disorder (cerebal palsy), cleft palate
  • chronic illness- renal/ hepatic failure
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4
Q

give some non-organic/ environmental causes that could lead to a child failing to thrive

A
  • availability of calories/ food !- insufficent breast milk, incorrect formulae, lack of regular feeding times, poverty
  • psychosocial deprivation- poor maternal infant interaction, maternal depression, neglect/ abuse
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5
Q

other than organic and environmental causes of failure to thrive, give some other possible causes

A
  • inadequate absorption- coeliac, lactose intolerance, pancreatic disease
  • excessive calorie loss- GORD/ pyloric stenosis
  • excessive calorie requirements- chronic illness, malignancy
  • failure to use calories- chromosomal abnormalities, metabolic abnormalities
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6
Q

what are the 4 domains of childhood development?

A
  • gross motor
  • fine motor and vision
  • language and hearing
  • social
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7
Q

when would you want to assess a childs development?

A
  • standard surveillance
  • concerns from family/ nursery etc
  • known genetic risk
  • macro/microcephaly
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8
Q

how is childhood development assessed?

A
  • milestones- smiling, siting, walking, talking and understanding
  • physical- features, systems exams, general measurements (height, weight etc)
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9
Q

describe the general normal progression of gross motor function at;
- 6 weeks

  • 6-9 months
  • 1 year
  • 18 months
  • 2 years
  • 3 years
  • 4 years
A
  • 6 weeks- can hold head for a few seconds
  • 6-9 months- sits with support, crawls
  • 1 year- walks alone/ holding one hand
  • 18 months- can walk well
  • 2 years- can run
  • 3 years- can go upstairs, able to balance on one leg
  • 4 years- hop, throw, catch and kick
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10
Q

describe the general normal progression of fine motor/ vision function at;
- 6 weeks

  • 6-9 months
  • 1 year
  • 18 months
  • 2 years
  • 3 years
  • 4 years
A
  • 6 weeks- stares, follows face in 90’ arc
  • 6-9 months- palmar grasp, probing with index
  • 1 year- neat pincer grip, can bang things together
  • 18 months- can tower bricks, can hold pencil in fist
  • 2 years- 6-8 tower of bricks, can copy vertical/ horizontal lines
  • 3 years- copies circles
  • 4 years- can copy a cross and a square
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11
Q

describe the general normal progression of hearing/ language at;
- 6 weeks

  • 6-9 months
  • 1 year
  • 18 months
  • 2 years
  • 3 years
  • 4 years
A
  • 6 weeks- still to mothers voice
  • 6-9 months- mama/ dada
  • 1 year- 1-3 words, can understand no
  • 18 months- obeys single commands
  • 2 years- understands 2-3 word phrases
  • 3 years- full name and sex understanding
  • 4 years- count to ten, good pronunciation
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12
Q

describe the general normal progression of social function at;
- 6 weeks

  • 6-9 months
  • 1 year
  • 18 months
  • 2 years
  • 3 years
  • 4 years
A
  • 6 weeks- smiling
  • 6-9 months- mouthing
  • 1 year- cooperates with dressing
  • 18 months- drink from cup, feed from spoon
  • 2 years- plays alone, imaginative play
  • 3 years- shares toys
  • 4 years- can dress independently (except laces)
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13
Q

define developmental delay

A

Development along normal route but takes longer to reach milestones compared with normal route

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14
Q

define developmental disorder

A

Development does not follow normal pattern

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15
Q

define developmental arrest/ regression

A
  • normal initially

- then failure to gain skills/ slowed rate/ loss of skills

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16
Q

give some red flags for a developmental disorder/ developmental delay

A
  • biological- prematurity, low birth weight, birth asphyxia, chronic illness, hearing/ vision impairment
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17
Q

give some environmental risk factors for developmental disorders/ delay

A
  • poverty
  • low parental education
  • parental mental illness
  • maternal alcohol/ drugs
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18
Q

what are the primitive reflexes and when do they occur?

A
  • stepping- 0-6 weeks
  • palmar and plantar grasp-0-3 months
  • moro- 0-4 months
  • atonic neck reflex- 0-6 months
  • sucking and rooting- 0-6 months
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19
Q

describe the postural reflexes and when do these usually emerge

A

emerge at 3-8 months

  • parachute reflex
  • positive support
  • landau
  • lateral propping
20
Q

what does persistence of primitive reflexes and a lack of development of postural reflexes imply?

A

hallmark of motor neuron abnormality in the infant

21
Q

define childhood disability

A

Physical or mental impairment preventing them going about their day to day tasks

22
Q

describe the 5 key steps of newborn resuscitation

A

1- dry baby and maintain temperature

2- assess tone, resp rate and heart rate

3- if gasping/ not breathing, give 5 inflation breaths

4- reassess (chest movements)

5- if heart rate is <60bpm, start compressions and ventilation breaths at a rate of 3:1

23
Q

describe the compression:ventilation ratio used in paediatric patients

A

if on own- 30:2

if more than one person- 15:2

24
Q

define sepsis

A

dysregulated host response leading to end organ dysfunction

25
Q

management of sepsis

A

sepsis 6

  • 3 out ! - bloods (lactate and FBC), urine output, blood culture
  • 3 in- fluids, oxgen (94-98%), abx (cefotaxime)
26
Q

describe the traffic light system for feverish illness (i.e. what is assessed)

A
  • used in children under 5
  • applied until a clinical diagnosis is made
  • assess temperature, CRT, resp rate, heart rate
27
Q

what is Apgar and what does it assess?

A

measure of physical condition of a newborn infant- scored out of 10

assesses pulse, respiration, muscle tone, colour and response to suction

28
Q

what is respiratory distress syndrome?

A

seen in premature infants

caused by insufficient surfactant production and structural immaturity of the lungs

29
Q

describe the % risk of respiratory distress syndrome by gestational age

A

50% of infants born 26-28 weeks

25% of infants born at 30-31 weeks

30
Q

how does respiratory distress syndrome present clinically?

A

increased work of breathing in first 4 hours after birth:
- tachypnoea (greater than 60/min)

  • grunting
  • nasal flaring
  • intercostal recession
  • cyanosis
31
Q

how does respiratory distress syndrome present on a chest x ray?

A
  • ground glass appearance

- indistinct heart border

32
Q

differentials for respiratory distress syndrome

A
  • sepsis
  • transient tachypnoea of newborn
  • meconium aspirate
33
Q

how is respiratory distress syndrome managed?

A
  • if premature risk (not born)- give dexamethasone to induce foetal lung maturation

when born:

  • oxygen
  • exogenous surfactant
34
Q

what is bronchopulmonary dysplasia?

A

lung damage caused by:

  • delay in lung maturation
  • pressure and volume trauma from artificial ventilation
  • oxygen toxicity
  • infection
35
Q

how does bronchopulmonary dysplasia present clinically?

A

persistent hypoxia and difficult ventilation weaning

36
Q

how is bronchopulmonary dysplasia managed?

A

steroids and surfactant

37
Q

what is meconium aspiration syndrome?

A

when meconium is passed in utero- leading to meconium stained amniotic fluid

this is then aspirated

38
Q

when should meconium aspiration syndrome be considered a likely diagnosis?

A

when there is meconium stained amniotic fluid + respiratory distress with no other explanation

39
Q

RF for meconium aspiration syndrome

A
  • maternal HTN
  • pre-eclampsia
  • chorioamnionitis
  • smoking
40
Q

clinical features of meconium aspiration syndrome

A
  • respiratory distress
  • airway obstruction
  • infection
41
Q

how is meconium aspiration syndrome managed?

A
  • surfactant
  • inhaled nitric oxide
  • Abx
42
Q

what is transient tachypnoea of newborn?

A

delay in resorption of lung liquid

most common cause of respiratory distress in term infants

common after caesarean

43
Q

features of early Group-B strep infection

A

respiratory distress

pneumonia

44
Q

features of late Group-B strep infection

A

meningitis

focal infections- osteomyelitis, septic arthritis

up to 3 months of age !

45
Q

how is Group-B strep infection managed?

A

prophylactic IV Abx to mother

NP- Phase 3a Medicine (22 decks)

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