PAEDS - neonatology Flashcards
healthy newborns should have a…
a) RR
b) pulse
c) temperature
a) 30-60 breaths per min
b) regular between 100-160 beats per min
c) around 37 celsius
most common congenital infection
cytomegalovirus
key signs of congenital rubella syndrome in a newborn (4)
- sensorineural deafness
- congenital cataracts
- glaucoma
- CHD e.g. PDA
think eyes and ears!
key signs of congenital cytomegalovirus infection in a newborn (4)
- LBW
- purpuric skin lesions
- microcephaly
- sensorineural deafness
think small, skin lesions
key signs of congenital toxoplasmosis infection in a newborn (3)
- cerebral calcification (intracranial)
- chorioretinitis (inflammation of choroid and retina of eye)
- hydrocephalus
think big, calcium
tx for baby with congenital toxoplasmosis
pyrimethamine and sulfadiazine
key signs of congenital varicella syndrome in a newborn (4)
- skin scarring
- microphthalmia (small eyes)
- limb hypoplasia
- microcephaly (small head/brain)
what is an epstein’s pearl?
congenital cyst found in mouth - common on hard palate but may be seen on gums (mistaken for erupting tooth)
not harmful, will resolve by itself
presentation of caput succadeneum
- commonly seen in newborns immediately after birth
- generalised superficial scalp oedema which Crosses Suture lines
- associated with prolonged labour
- will rapidly resolve over a couple of days
presentation of cephalohematoma
- associated with instrumental deliveries
- appears 2-3 days following delivery
- swelling in parietal region
- gradually resolves over weeks
stepwise principles of neonatal resus
- warm baby - rigorous drying
- calculate APGAR score
- stimulate breathing e.g. by rigorous drying
- inflation breaths
- chest compressions
- if severe > IV drugs and intubation
how are babies <28 kept warm during resus?
place in plastic bag while still wet, manage under heat lamp
when are inflation breaths given in neonatal resus?
how are they given if
a) term/near term
b) preterm
when gasping/not breathing despite adequate initial stimulation
a) air
b) mix of air and O2
stepwise principles of inflation breaths in neonatal resus
- two cycles of five inflation breaths (lasting 3 secs each)
- if no response and HR still low, 30 seconds of ventilation breaths
- if STILL no response, add chest compressions
when are chest compressions performed in neonatal resus?
how are they performed?
if HR remains <60bpm despite resus and inflation breaths
performed at 3:1 ratio with vent breaths
delayed cord clamping in
a) uncompromised neonates
b) neonates that require resus
a) delay of at least 1 minute before clamping
b) cord clamped sooner - prevents delays getting to resus team
what is necrotising enterocolitis?
intestinal inflammation and death in premature babies
which babies are most at risk of necrotising enterocolitis?
premature babies
presentation of necrotising enterocolitis
neonate with:
- bilious vomiting
- reduced feeding
- abdo distension
- bloody stools
key investigation and results for necrotising enterocolitis
X-RAY (chest and abdo)
- dilated bowel loops
- portal venous gas
- intramural gas
- Rigler’s sign (air both inside and outside the bowel wall)
management of necrotising enterocolitis
STAIN:
S - surgical emergency
T - total parenteral nutrition
A - abx (vancomycin + cefotaxime)
I - IV fluids
N - nil by mouth
complications of necrotising enterocolitis
perforation, peritonitis
RFs for gastroschisis/exomphalos (6)
- maternal smoking
- alcohol
- illicit drug use
- young (gastrochisis)/old (exomphalos) maternal age
- SES
- opioid prescription in pregnancy
- DS (exom)
when is gastrochisis/exomphalos normally diagnosed? with what? what will the result be?
antenatally diagnosed at 20 weeks
1. USS scan - bowel free-floating in amniotic fluid
2. maternal bloods - raised AFP
how does gastroschisis present in neonates?
- lateral (right-side) of umbilical cord
- abdominal contents exposed to air
management of gastroschisis including type of delivery (5)
- vaginal delivery can be attempted - 37/40
- immediate fluid resus
- sterile, clear covering of abdo contents
- immediate surgery (if large may need staged repair)
- then NG tube and parenteral feeding
how does exomphalos present in neonates?
- abdominal contents protrude through abdo wall via umbilical cord
- covered in amniotic sac
conditions associated with exomphalos (4)
- Beckwith-Wiedemann syndrome
- DS
- cardiac/kidney malformations
- edwards
management of exomphalos including type of birth
- c-section preferred (prevents sac rupture)
- OG tube to decompress stomach
- IV fluid resus
- staged repair surgery
management of exomphalos if sac ruptures
immediate surgical intervention
causes of hypoxic ischaemic encephalopathy (HIE) (6)
- maternal shock e.g. placental abruption, uterine rupture
- intrapartum haemorrhage
- prolapsed cord
- nuchal cord (wrapped around neck of baby)
- prolonged labour
- shoulder dystocia
general signs and symptoms of HIE
- highly alert/v low energy
- trouble breathing
- not eating
- trouble hearing
- seizures/other neuro
- slow HR
- organ failure
what system is used to stage HIE? how many stages are there?
Sarnat staging
3 stages - mild, moderate, severe
mild HIE features (signs, resolves when, prognosis)
- poor feeding, generally irritable and hyper-alert
- resolves within 24h
- normal prognosis
moderate HIE features (signs, resolves when, prognosis)
- poor feeding, lethargy, hypotonic, seizures
- can take weeks to resolve
- up to 40% develop cerebral palsy
severe HIE features (signs, mortality)
- reduced consciousness, apnoeas, flaccid, reduced/absent reflexes
- up to 50% mortality
- up to 90% develop cerebral palsy
what is the diagnosis of HIE often based off of?
child’s symptoms and problems that took place during labour/delivery
investigations to confirm HIE diagnosis (4)
- bloods - check O2
- test blood in umbilical cord/examine placenta (identify cause)
- USS of head
- brain MRI (only at 4-7 days old!)
initial management of HIE
therapeutic hypothermia/cooling
therapeutic cooling for HIE
a) which babies
b) target temp
c) how long for
d) what is done after
a) near/at term with HIE
b) 33-34 degrees
c) continued for 72h
d) baby gradually warmed to normal temp over 6h
supportive management for HIE
- neonatal resus
- ongoing optimal ventilation
- circ support
- nutrition
- acid base balance
- tx of seizures
complications of HIE (3)
- permanent damage to brain - CP
- death
- delays in growth/development
features of congenital syphilis (8)
- blunted upper incisor teeth (Hutchinson’s teeth)
- saddle nose
- saber shins (tibial malformation)
- rhagades (linear scars around mouth)
- deafness
- lymphadenopathy
- hepatosplenomegaly
- rash
jaundice in the first 24 hours of life is always…
pathological
causes of jaundice in first 24h (4)
- rhesus haemolytic disease
- ABO haemolytic disease
- hereditary spherocytosis
- glucose-6-phosphodehydrogenase deficiency (G6PD)
causes of jaundice in days 2-14
normally physiological!
causes of prolonged jaundice (>21 days in term infant, >14 in preterm infant) (5)
- biliary atresia
- breastmilk jaundice
- hypothyroidism
- congenital infection e.g. CMV, toxoplasmosis
- prematurity (immature liver function)
when is a transcutaneous bilirubinometer used first line for jaundice?
- baby >35w
- prolonged (not within 24hr)
what ix is first line for jaundice if baby is <35w or it is within the first 24hr?
serum bilirubin
2nd line investigation for jaundice if transcutaneous bilirubinometer is >250
serum bilirubin
investigations in a jaundice screen
- serum conjugated and unconjugated bilirubin
- direct antiglobulin test (Coomb’s)
- TFTs
- FBC and blood film
- urine
- U&Es, LFTs
prolonged jaundice and a raised conjugated bilirubin indicates…
biliary atresia
investigations for baby presenting w jaundice in first 24h
- serum bilirubin
- FBC
- blood groups
- direct Coomb’s test
- blood film
- TORCH screen
- urine dip/microscopy
management of prolonged jaundice
- treat cause
- phototherapy (on/above blue line)
- exchange transfusion (on/above red line)
what is kernicterus? what is its pathophys?
neurological complication of neonatal jaundice
bilirubin crosses BBB and deposits in basal ganglia
presentation of kernicterus
history of jaundice then…
- floppy, drowsy baby
- poor feeding
complications of kernicterus (3)
- CP
- learning disability
- deafness
when is the blood spot screening test performed?
5-9 days of life
innocent murmurs - 5 Ss
soft, systolic, short, symptomless, standing/sitting (vary w position)
what is biliary atresia
congenital condition - extrahepatic bile duct is either narrowed or obliterated. progressive necro inflammatory process
pathophys of biliary atresia
- inflammation/absence of tree
- discontinuous/obliterated bile ducts
- obstruction in bile flow (cholestasis) > bile cannot be transported from LIVER to bowel
- CONJUGATED bilirubin cannot be excreted
- OBSTRUCTIVE JAUNDICE
presentation of biliary atresia
- first few weeks of life
- prolonged jaundice
- dark urine, pale stools
- failure to thrive
investigations and results for biliary atresia (3)
- BLOODS
- raised serum conjugated bilirubin
- deranged LFTs - NEWBORN SCREEN
- rule out CF
- usually normal - ABDO USS
- triangular cord sign
- liver may be enlarged
1st line tx for biliary atresia
Kasai procedure - portoenterostomy
(2nd line is liver transplant if end-stage)
what is oesophageal atresia? what other conditions may it occur with?
congenital abnormality of the oesophagus where the upper and lower parts aren’t connected
may occur with tracheo-oesophageal fistula and polyhydramnios
what is a tracheo-oesophageal fistula?
abnormal connection between oesophagus and trachea
when is oesophageal atresia normally diagnosed?
antenatally
presentation of oesophageal atresia if not diagnosed antenatally (6)
- resp distress
- cyanosis
- choking + cyanotic spells following aspiration
- frothy white bubbles in mouth
- coughing
- pneumonia from aspirating stomach contents
management of oesophageal atresia
surgery within 12-24h
what is duodenal atresia?
congenital malformation of the duodenum - doesn’t join with rest of small intestine, causing complete bowel obstruction
what is the duodenum?
first part of the small intestine, connects to the stomach
RF for duodenal atresia
down’s syndrome
presentation of duodenal atresia
FIRST FEW DAYS OF LIFE…
- projectile vomiting
- abdo distension
- absent bowel movements
main investigation and result for duodenal atresia
abdo x-ray - double bubble sign
management of duodenal atresia (2)
- decompress stomach with NG
- surgery=
duodenoduodenostomy
complications of duodenal atresia (2)
- polyhydramnios > preterm labour/rupture
- malnutrition/weight loss
what is transient tachypnoea of the newborn (TTN)?
commonest cause of resp distress in the newborn period
what causes TNN? what is a RF?
- caused by delayed resorption of fluid in the lungs
- c-sections > lung fluid not ‘squeezed out’ during passage through birth canal
what will be seen on CXR in TNN?
hyperinflation of lungs
fluid in horizontal fissure
management of TTN
- observation, supportive care
- supplementary O2 potench
group B strep organism
streptococcus agalactiae
tx for baby with neonatal abstinence syndrome
IV phenobarbital
