Paeds- Neonatal Medicine Flashcards
Define failure to thrive
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
what is the most common cause for failure to thrive?
inadequate calorie intake
give some organic causes that could lead to a child failing to thrive
- impaired suck/ swallow- motor dysfunction, neuro disorder (cerebal palsy), cleft palate
- chronic illness- renal/ hepatic failure
give some non-organic/ environmental causes that could lead to a child failing to thrive
- 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
other than organic and environmental causes of failure to thrive, give some other possible causes
- 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
what are the 4 domains of childhood development?
- gross motor
- fine motor and vision
- language and hearing
- social
when would you want to assess a childs development?
- standard surveillance
- concerns from family/ nursery etc
- known genetic risk
- macro/microcephaly
how is childhood development assessed?
- milestones- smiling, siting, walking, talking and understanding
- physical- features, systems exams, general measurements (height, weight etc)
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
- 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
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
- 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
describe the general normal progression of hearing/ language at;
- 6 weeks
- 6-9 months
- 1 year
- 18 months
- 2 years
- 3 years
- 4 years
- 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
describe the general normal progression of social function at;
- 6 weeks
- 6-9 months
- 1 year
- 18 months
- 2 years
- 3 years
- 4 years
- 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)
define developmental delay
Development along normal route but takes longer to reach milestones compared with normal route
define developmental disorder
Development does not follow normal pattern
define developmental arrest/ regression
- normal initially
- then failure to gain skills/ slowed rate/ loss of skills
give some red flags for a developmental disorder/ developmental delay
- biological- prematurity, low birth weight, birth asphyxia, chronic illness, hearing/ vision impairment
give some environmental risk factors for developmental disorders/ delay
- poverty
- low parental education
- parental mental illness
- maternal alcohol/ drugs
what are the primitive reflexes and when do they occur?
- 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
describe the postural reflexes and when do these usually emerge
emerge at 3-8 months
- parachute reflex
- positive support
- landau
- lateral propping
what does persistence of primitive reflexes and a lack of development of postural reflexes imply?
hallmark of motor neuron abnormality in the infant
define childhood disability
Physical or mental impairment preventing them going about their day to day tasks
describe the 5 key steps of newborn resuscitation
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
describe the compression:ventilation ratio used in paediatric patients
if on own- 30:2
if more than one person- 15:2
define sepsis
dysregulated host response leading to end organ dysfunction
management of sepsis
sepsis 6
- 3 out ! - bloods (lactate and FBC), urine output, blood culture
- 3 in- fluids, oxgen (94-98%), abx (cefotaxime)
describe the traffic light system for feverish illness (i.e. what is assessed)
- used in children under 5
- applied until a clinical diagnosis is made
- assess temperature, CRT, resp rate, heart rate
what is Apgar and what does it assess?
measure of physical condition of a newborn infant- scored out of 10
assesses pulse, respiration, muscle tone, colour and response to suction
what is respiratory distress syndrome?
seen in premature infants
caused by insufficient surfactant production and structural immaturity of the lungs
describe the % risk of respiratory distress syndrome by gestational age
50% of infants born 26-28 weeks
25% of infants born at 30-31 weeks
how does respiratory distress syndrome present clinically?
increased work of breathing in first 4 hours after birth:
- tachypnoea (greater than 60/min)
- grunting
- nasal flaring
- intercostal recession
- cyanosis
how does respiratory distress syndrome present on a chest x ray?
- ground glass appearance
- indistinct heart border
differentials for respiratory distress syndrome
- sepsis
- transient tachypnoea of newborn
- meconium aspirate
how is respiratory distress syndrome managed?
- if premature risk (not born)- give dexamethasone to induce foetal lung maturation
when born:
- oxygen
- exogenous surfactant
what is bronchopulmonary dysplasia?
lung damage caused by:
- delay in lung maturation
- pressure and volume trauma from artificial ventilation
- oxygen toxicity
- infection
how does bronchopulmonary dysplasia present clinically?
persistent hypoxia and difficult ventilation weaning
how is bronchopulmonary dysplasia managed?
steroids and surfactant
what is meconium aspiration syndrome?
when meconium is passed in utero- leading to meconium stained amniotic fluid
this is then aspirated
when should meconium aspiration syndrome be considered a likely diagnosis?
when there is meconium stained amniotic fluid + respiratory distress with no other explanation
RF for meconium aspiration syndrome
- maternal HTN
- pre-eclampsia
- chorioamnionitis
- smoking
clinical features of meconium aspiration syndrome
- respiratory distress
- airway obstruction
- infection
how is meconium aspiration syndrome managed?
- surfactant
- inhaled nitric oxide
- Abx
what is transient tachypnoea of newborn?
delay in resorption of lung liquid
most common cause of respiratory distress in term infants
common after caesarean
features of early Group-B strep infection
respiratory distress
pneumonia
features of late Group-B strep infection
meningitis
focal infections- osteomyelitis, septic arthritis
up to 3 months of age !
how is Group-B strep infection managed?
prophylactic IV Abx to mother
