Paeds - Neonates Flashcards
Drugs used in paeds resus
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
APGAR score
Appearance Pulse Grimace Activity Respiration
Neonatal jaundice
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
Neonatal jaundice < 24 hours
BAD
Rhesus incompatibility ABO incompatibility Hereditary spherocytosis G6PD Infection Sepsis
Neonatal jaundice
24 hours - 2 weeks
NORMAL
Dehydration
Infection
Physiological
Breastfeeding
Neonatal jaundice > 2 weeks
Cystic fibrosis Congenital hypothyroidism Pyloric stenosis Hepatitis Biliary atresia Infection
HIGH CONJUGATED BILIRUBIN = BILIARY ATRESIA!
Neonatal jaundice investigations
Conjugated bilirubin
Unconjugated bilirubin
Coombs test
Blood film
FBC
U/E
LFT
TFT
Urinalysis
What is kernicterus
Deposition of unconjugated bilirubin in the basal ganglia
Presentation
- Arching of back
- Seizures
- Coma
Complications
- Learning difficulties
- Sensorineural deafness
- Cerebral palsy
TORCH infections
Toxoplasmosis
- Hydrocephalus
- Cerebral calcification
Other
- Syphilis
- VZV
- Parvovirus B19
Rubella
- Deafness
- Cataracts
- Heart disease
CMV
- Growth retardation
- Skin lesions
HSV - Encephalitis
Neonatal infections
GBS - Pneumonia, meningitis
Listeria - Pneumonia, meningitis, meconium aspiration
Conjunctivitis - Staph, strep, gonococcal, chlamydia trachomatis
HSV - Encephalitis
RDS aetiology
Surfactant deficient lung disease
Insufficient surfactant + structural immaturity of lungs
Prematurity
Maternal diabetes
CS
Male sex
Second born of premature twins
RDS prevention / presentation / investigations
Prophylaxis
- Dexamethasone
- Delayed cord clamping - 45 seconds
Tachypnoea
Intercostal recession
Expiratory grunting
Cyanosis
CXR - Ground glass appearance
RDS management and complications
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
BPD investigations and management
O/E - Crackles and wheeze
CXR
- Round radiolucent areas
- Fibrosis
CT - Mosaic lunch parenchyma
Management
- Dexamethasone
- Palivizumab
- LTOT
Hypoxic ischaemic encephalopathy aetiology and clinical features
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
HIE diagnosis / management / complications
MRI changes…
- Thalamus
- Basal ganglia
- Internal capsule
O2
Anticonvulsants
Complications
- Cerebral palsy
- Seizures
- DIC
- Renal failure
NEC aetiology and presentation
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
NEC investigations - AXR
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
NEC management
BROAD SPECTRUM ABX
- Cefotaxime
- Vancomycin
- Gentamicin
Drip and suck - NG decompression + IV fluids
Surgery - Bowel resection
Complications
- Perforation
- Peritonitis
- Short bowel syndrome - Following surgery
Birth injuries
Femoral fracture
DDH
Brachial plexus palsy
Gastroschisis
Defect in abdominal wall
Adjacent to umbilicus
Bowel protrudes outwards
No covering sac
Management - Cling film!
- Minimise fluid loss
- IV dextrose
- NG tube
- Surgery
Omphalocoele
Bowel protrudes outwards
Through umbilical ring
Membrane covering - Amniotic membrane + peritoneum
Surgery at 6-12 months
Associated with…
- Imperforate anus
- Spinal defects
Cleft lip and palate
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
Oesophageal atresia
Associations
- ToF
- VACTERL
Presentation
- Choking
- Polyhydramnios
- Aspiration
Meconium aspiration
Post-term infants
Meconium passes before birth - In response to foetal distress
Meconium = Lung irritant = Pneumonitis
CXR - Hyperinflation
Complications - PPHTN
