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A TO REVISE - PHASE 3A > PAEDS NEONATAL TO DO > Flashcards

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
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2
Q

RDS
What is the investigation for RDS?

A

CXR –

  • Reticular “ground-glass” changes
  • Heart borders indistinct
  • Air bronchograms
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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
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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
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5
Q

NEC. ENTEROCOLITIS
What are some investigations for necrotising enterocolitis?

A
  • Blood culture (sepsis)
  • CRP
  • Capillary blood gas = metabolic acidosis
  • AXR is diagnostic
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6
Q

JAUNDICE
What are some risk factors for jaundice?

A
  • LBW
  • Breastfeeding
  • Prematurity
  • FHx
  • Maternal diabetes
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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)
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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
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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
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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
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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
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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
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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
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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
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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
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16
Q

TORCH
What are the TORCH conditions?

A

Main congenital conditions
- Toxoplasmosis,
- Other (HIV),
- Rubella,
- CMV,
- Herpes + Syphilis

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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
Q

OESOPHAGEAL ATRESIA
What is the clinical presentation of oesophageal atresia?

A
  • Persistent salivation + drooling from mouth after birth
  • May cough + choke when fed + have cyanotic aspiration
  • Some have other congenital malformations (VACTERL association)
26
Q

GASTROSCHISIS
What is a complication of gastroschisis?

A

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
Q

BRONCHOPULMONARY DYSPLASIA
What is chronic lung disease of prematurity, or bronchopulmonary dysplasia?

A
  • Premature babies often <28w diagnosed when infant requires oxygen therapy after they reach 36w gestation
28
Q

BRONCHOPULMONARY DYSPLASIA
What investigations would you do for bronchopulmonary dysplasia?

A
  • CXR = widespread areas of opacification, cystic changes, fibrosis
  • Formal sleep study to assess SpO2 during sleep supports Dx + guides Mx
29
Q

BRONCHOPULMONARY DYSPLASIA
How can bronchopulmonary dysplasia be prevented?

A
  • Corticosteroids to mothers in premature labour <34w
  • CPAP rather than intubation where possible
  • Use caffeine to stimulate resp effort
  • Do not over oxygenate
30
Q

GROUP B STREP INFECTION
which babies are at more risk of becoming infected with group B strep?

A
  • 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
Q

GROUP B STREP INFECTION
what are the symptoms of group B strep infection in babies are a week old?

A
  • 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
Q

GROUP B STREP INFECTION
what are the symptoms of group B strep infection in pregnant women?

A
  • 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
Q

PREMATURITY
What are some metabolic complications of prematurity?

A
  • Hypoglycaemia,
  • hypocalcaemia,
  • electrolyte imbalance,
  • fluid imbalance
  • hypothermia
34
Q

JAUNDICE
How does kernicterus present?
What are the outcomes?

A
  • Lethargy, poor feeding > hypertonia, seizures + coma
  • Permanent damage = dyskinetic cerebral palsy, LD + deafness
35
Q

JAUNDICE
What are some side effects of phototherapy?

A
  • Temp instability,
  • macular rash,
  • bronze discolouration
36
Q

NEONATAL HYPOGLYCAEMIA
What are some risk factors for neonatal hypoglycaemia?

A
  • 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
Q

TORCH
How is CMV managed?

A

No therapy so no screening

38
Q

TORCH
How is syphillis managed?

A
  • If fully treated ≥1m before delivery = no treatment
  • Any doubts = benzylpenicillin
39
Q

OESOPHAGEAL ATRESIA
What is it associated with?

A
  • Tracheo-oesophageal fistula + polyhydramnios
40
Q

LISTERIA INFECTION
what is the clinical presentation?

A

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
Q

LISTERIA INFECTION
what is the management?

A

ampicillin + aminoglycoside (gentamycin)

A TO REVISE - PHASE 3A (16 decks)

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