PAEDS NEONATAL TO DO Flashcards
1
Q
RDS
What are some risk factors of RDS?
A
- Prematurity #1
- Maternal DM
- 2nd premature twin
- C-section
2
Q
RDS
What is the investigation for RDS?
A
CXR –
- Reticular “ground-glass” changes
- Heart borders indistinct
- Air bronchograms
3
Q
RDS
What are the short and long term complications of RDS?
A
- Short = pneumothorax, infection, apnoea, necrotising enterocolitis
- Long = bronchopulmonary dysplasia, retinopathy of prematurity
4
Q
NEC. ENTEROCOLITIS
What are some risk factors for necrotising enterocolitis?
A
- Very LBW + premature
- Formula feeds (breast milk protective)
- RDS + assisted ventilation
- Sepsis
- PDA + other CHD
5
Q
NEC. ENTEROCOLITIS
What are some investigations for necrotising enterocolitis?
A
- Blood culture (sepsis)
- CRP
- Capillary blood gas = metabolic acidosis
- AXR is diagnostic
6
Q
JAUNDICE
What are some risk factors for jaundice?
A
- LBW
- Breastfeeding
- Prematurity
- FHx
- Maternal diabetes
7
Q
JAUNDICE
What are some causes of jaundice 24h–2w after birth?
A
- Physiological + breast milk jaundice (common)
- Infection (UTI, sepsis)
- Haemolysis, polycythaemia, bruising
- Crigler-Najjar syndrome (rare inherited disorder with no UGT enzyme)
8
Q
JAUNDICE
What are some causes of jaundice >2w after birth?
A
- Unconjugated = physiological or breast milk, UTI, hypothyroid, high GI obstruction (pyloric stenosis), Gilbert syndrome
- Conjugated (>25umol/L) = bile duct obstruction (biliary atresia), neonatal hepatitis
9
Q
JAUNDICE
What might cause breast milk jaundice?
A
- Components of breast milk inhibiting liver to process bilirubin
- Increased bilirubin absorption
- Inadequate feeds > slow passage of stools
10
Q
JAUNDICE
What is Gilbert’s syndrome?
How does it present?
A
- AR deficiency of UDP-glucuronyltransferase = defective bilirubin conjugation
- Unconjugated hyperbilirubinaemia (not in urine), jaundice may only be present if ill, exercising or fasting
11
Q
JAUNDICE
What investigations would you perform in neonatal jaundice?
A
- 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
12
Q
JAUNDICE
When measuring bilirubin levels what are you looking for?
How would you measure bilirubin levels depending on age?
A
- Split bilirubin = unconjugated (extra-hepatic) or conjugated (hepatobiliary)
- > 24h old = transcutaneous bilirubin meter if high, serum to confirm within 6h
- <24h old = serum bilirubin within 2h
13
Q
JAUNDICE
What is the main complication of jaundice?
What is it?
A
- Kernicterus
- Bilirubin-induced encephalopathy caused by unconjugated bilirubin deposition in brain (basal ganglia + brainstem nuclei) as baby’s BBB are not well developed
14
Q
HIE
What happens as a result of cardiorespiratory depression?
A
- Hypoxia, hypercarbia + metabolic acidosis
- Compromised cardiac output reduces tissue perfusion > hypoxic ischaemic injury to brain
15
Q
HIE
What is used to stage the severity of HIE?
What are the stages?
A
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
16
Q
TORCH
What are the TORCH conditions?
A
Main congenital conditions
- Toxoplasmosis,
- Other (HIV),
- Rubella,
- CMV,
- Herpes + Syphilis
17
Q
TORCH
What are the characteristic features of toxoplasmosis?
A
- Cerebral calcification, chorioretinitis + hydrocephalus
18
Q
TORCH
What is CMV?
How is it contracted?
A
- Most common congenital infection
- Herpes simplex virus via personal contact
19
Q
TORCH
What is the clinical presentation of CMV?
A
- 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
20
Q
TORCH
How does herpes simplex virus present?
A
- Herpetic lesions on skin or eye, encephalitis or disseminated disease
21
Q
TORCH
How does syphilis present?
A
- Rash on soles of feet + hands
- Hutchinson’s triad = keratitis, deafness, small + pointed teeth
22
Q
MECONIUM ASPIRATION
What are some risk factors for meconium aspiration?
A
- Post-term deliveries at 42w
- Maternal HTN or pre-eclampsia
- Smoking or substance abuse
- Chorioamnionitis
23
Q
MECONIUM ASPIRATION
What is a complication of meconium aspiration?
What are some other risk factors for that complication?
A
- Persistent pulmonary HTN of the newborn due to high pulmonary vascular resistance
- RDS, sepsis, congenital diaphragmatic hernia, maternal SSRI use, maternal NSAID use in 3rd trimester (early closure of DA)
24
Q
MECONIUM ASPIRATION
What is the management of meconium aspiration?
A
- Artificial (positive pressure) ventilation with oxygenation
- Suction if no breathing
25
OESOPHAGEAL ATRESIA
What is the clinical presentation of oesophageal atresia?
- Persistent salivation + drooling from mouth after birth
- May cough + choke when fed + have cyanotic aspiration
- Some have other congenital malformations (VACTERL association)
26
GASTROSCHISIS
What is a complication of gastroschisis?
Higher risk of dehydration + protein loss –
- Wrap infants in several layers of clingfilm to minimise fluid + heat loss
- NG tube passed + aspirated frequently
- IVI dextrose + colloid support for protein loss
27
BRONCHOPULMONARY DYSPLASIA
What is chronic lung disease of prematurity, or bronchopulmonary dysplasia?
- Premature babies often <28w diagnosed when infant requires oxygen therapy after they reach 36w gestation
28
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
29
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
30
GROUP B STREP INFECTION
which babies are at more risk of becoming infected with group B strep?
- preterm labour
- premature rupture of membranes
- a long time between rupture of membranes and birth
- internal foetal monitor
- fever
- past pregnancy with baby who had strep B
- african-american/hispanic
- group B strep in urine during pregnancy
31
GROUP B STREP INFECTION
what are the symptoms of group B strep infection in babies are a week old?
- decreased movement in arm or leg
- pain with movement of arm or leg
- breathing problems
- fever
- red area on face or other part of the body
32
GROUP B STREP INFECTION
what are the symptoms of group B strep infection in pregnant women?
- having to urinate often
- having a sudden urge to urinate
- pain when urinating
- fever
- nausea and vomiting
- pain in side or back
- uterus or belly is sore
- fast heart rate
33
PREMATURITY
What are some metabolic complications of prematurity?
- Hypoglycaemia,
- hypocalcaemia,
- electrolyte imbalance,
- fluid imbalance
- hypothermia
34
JAUNDICE
How does kernicterus present?
What are the outcomes?
- Lethargy, poor feeding > hypertonia, seizures + coma
- Permanent damage = dyskinetic cerebral palsy, LD + deafness
35
JAUNDICE
What are some side effects of phototherapy?
- Temp instability,
- macular rash,
- bronze discolouration
36
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
37
TORCH
How is CMV managed?
No therapy so no screening
38
TORCH
How is syphillis managed?
- If fully treated ≥1m before delivery = no treatment
- Any doubts = benzylpenicillin
39
OESOPHAGEAL ATRESIA
What is it associated with?
- Tracheo-oesophageal fistula + polyhydramnios
40
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
41
LISTERIA INFECTION
what is the management?
ampicillin + aminoglycoside (gentamycin)
