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3A > Paeds - Neonates > Flashcards

Paeds - Neonates Flashcards

1
Q

Drugs used in paeds resus

A

5 rescue breaths
15:2

HR < 60 - Adrenaline 1:10000

Lactic acidosis - Sodium bicarbonate 4.2%

Hypoglycaemia - 10% dextrose

Blood loss - Volume expander - 0.9% NaCl

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2
Q

APGAR score

A 
Appearance 
Pulse 
Grimace 
Activity 
Respiration
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3
Q

Neonatal jaundice

A

Physiological

  • RBC - Reduced lifespan - Increased breakdown
  • Immature hepatocytes - Decreased conjugation
  • Absence of gut flora - Decreased excretion
  • Feeding problems - Decreased elimination

< 24 hours - BAD
24 hours - 2 weeks - NORMAL
> 2 weeks - BAD

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4
Q

Neonatal jaundice < 24 hours

A

BAD

Rhesus incompatibility 
ABO incompatibility 
Hereditary spherocytosis 
G6PD 
Infection 
Sepsis
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5
Q

Neonatal jaundice

24 hours - 2 weeks

A

NORMAL

Dehydration
Infection
Physiological
Breastfeeding

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6
Q

Neonatal jaundice > 2 weeks

A 
Cystic fibrosis 
Congenital hypothyroidism 
Pyloric stenosis
Hepatitis 
Biliary atresia 
Infection

HIGH CONJUGATED BILIRUBIN = BILIARY ATRESIA!

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7
Q

Neonatal jaundice investigations

A

Conjugated bilirubin
Unconjugated bilirubin

Coombs test
Blood film

FBC
U/E
LFT

TFT

Urinalysis

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8
Q

What is kernicterus

A

Deposition of unconjugated bilirubin in the basal ganglia

Presentation

  • Arching of back
  • Seizures
  • Coma

Complications

  • Learning difficulties
  • Sensorineural deafness
  • Cerebral palsy
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9
Q

TORCH infections

A

Toxoplasmosis

  • Hydrocephalus
  • Cerebral calcification

Other

  • Syphilis
  • VZV
  • Parvovirus B19

Rubella

  • Deafness
  • Cataracts
  • Heart disease

CMV

  • Growth retardation
  • Skin lesions

HSV - Encephalitis

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10
Q

Neonatal infections

A

GBS - Pneumonia, meningitis

Listeria - Pneumonia, meningitis, meconium aspiration

Conjunctivitis - Staph, strep, gonococcal, chlamydia trachomatis

HSV - Encephalitis

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11
Q

RDS aetiology

A

Surfactant deficient lung disease
Insufficient surfactant + structural immaturity of lungs

Prematurity

Maternal diabetes
CS
Male sex
Second born of premature twins

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12
Q

RDS prevention / presentation / investigations

A

Prophylaxis

  • Dexamethasone
  • Delayed cord clamping - 45 seconds

Tachypnoea
Intercostal recession
Expiratory grunting
Cyanosis

CXR - Ground glass appearance

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13
Q

RDS management and complications

A

O2
CPAP
Surfactant therapy - Through ET tube

Pneumothorax
Retinopathy
Renal failure

Bronchopulmonary dysplasia

  • Chronic lung disease
  • Due to mechanical ventilation and O2 supplementation
  • Requires long-term oxygen therapy
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14
Q

BPD investigations and management

A

O/E - Crackles and wheeze

CXR

  • Round radiolucent areas
  • Fibrosis

CT - Mosaic lunch parenchyma

Management

  • Dexamethasone
  • Palivizumab
  • LTOT
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15
Q

Hypoxic ischaemic encephalopathy aetiology and clinical features

A

Lack of O2 - Leading to brain injury

Time - Prolonged uterine contractions
Maternal - Uterine rupture and cord compression
Foetal - Anaemia

Clinical features

  • Tone abnormality
  • Seizures
  • Hyperventilation
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16
Q

HIE diagnosis / management / complications

A

MRI changes…

  • Thalamus
  • Basal ganglia
  • Internal capsule

O2
Anticonvulsants

Complications

  • Cerebral palsy
  • Seizures
  • DIC
  • Renal failure
17
Q

NEC aetiology and presentation

A

Bacterial infection of ischaemic bowel wall
Inflammatory bowel necrosis due to premature GI tract

Risk factors - COWS MILK

Clinical features

  • Bilious vomiting
  • Distended abdomen - Tense, shiny and red
  • Blood in stool
  • Decreased bowel sounds
  • Palpable abdominal mass
  • Shock
18
Q

NEC investigations - AXR

A

FBC - Neutropenia + Thrombocytopenia
ABG - Metabolic acidosis

AXR

  • Intramural gas
  • Distended bowel
  • Thickening of bowel
  • Perforation - Pneumoperitoneum
  • Rigler sign - Air inside and outside bowel wall
  • Football sign - Air outlining falciform ligament
19
Q

NEC management

A

BROAD SPECTRUM ABX

  • Cefotaxime
  • Vancomycin
  • Gentamicin

Drip and suck - NG decompression + IV fluids

Surgery - Bowel resection

Complications

  • Perforation
  • Peritonitis
  • Short bowel syndrome - Following surgery
20
Q

Birth injuries

A

Femoral fracture
DDH
Brachial plexus palsy

21
Q

Gastroschisis

A

Defect in abdominal wall
Adjacent to umbilicus
Bowel protrudes outwards
No covering sac

Management - Cling film!

  • Minimise fluid loss
  • IV dextrose
  • NG tube
  • Surgery
22
Q

Omphalocoele

A

Bowel protrudes outwards
Through umbilical ring
Membrane covering - Amniotic membrane + peritoneum

Surgery at 6-12 months

Associated with…

  • Imperforate anus
  • Spinal defects
23
Q

Cleft lip and palate

A

Failure of frontonasal and maxillary process to fuse

Lip repair - 3 months
Palate repair - 9 months

Complications

  • Poor feeding - FTT
  • Psychological
  • S/L impairment
  • Hearing loss
24
Q

Oesophageal atresia

A

Associations

  • ToF
  • VACTERL

Presentation

  • Choking
  • Polyhydramnios
  • Aspiration
25
Q

Meconium aspiration

A

Post-term infants

Meconium passes before birth - In response to foetal distress
Meconium = Lung irritant = Pneumonitis

CXR - Hyperinflation

Complications - PPHTN

3A (31 decks)

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