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PHASE 3A > PAEDS - neonatology > Flashcards

PAEDS - neonatology Flashcards

1
Q

healthy newborns should have a…
a) RR
b) pulse
c) temperature

A

a) 30-60 breaths per min
b) regular between 100-160 beats per min
c) around 37 celsius

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2
Q

key signs of congenital rubella syndrome in a newborn (2)

A
  1. sensorineural deafness
  2. congenital cataracts
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3
Q

key signs of congenital cytomegalovirus infection in a newborn (5)

A
  1. sensorineural deafness
  2. CP
  3. anaemia
  4. jaundice
  5. periventricular calcifications
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4
Q

key signs of congenital toxoplasmosis infection in a feotus (3)

A
  1. cerebral calcification (intracranial)
  2. chorioretinitis (inflammation of choroid and retina of eye)
  3. hydrocephalus
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5
Q

tx for baby with congenital toxoplasmosis

A

pyrimethamine and sulfadiazine

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6
Q

key signs of congenital varicella syndrome in a newborn (4)

A
  1. skin scarring
  2. microphthalmia (small eyes)
  3. limb hypoplasia
  4. microcephaly (small head/brain)
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7
Q

what is an epstein’s pearl?

A

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

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8
Q

presentation of caput succadeneum

A
  • 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
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9
Q

presentation of cephalohematoma

A
  • associated with instrumental deliveries
  • appears 2-3 days following delivery
  • swelling in parietal region
  • gradually resolves over weeks
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10
Q

stepwise principles of neonatal resus

A
  1. warm baby - rigorous drying
  2. calculate APGAR score
  3. stimulate breathing e.g. by rigorous drying
  4. inflation breaths
  5. chest compressions
  6. if severe > IV drugs and intubation
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11
Q

how are babies <28 kept warm during resus?

A

place in plastic bag while still wet, manage under heat lamp

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12
Q

when are inflation breaths given in neonatal resus?

how are they given if
a) term/near term
b) preterm

A

when gasping/not breathing despite adequate initial stimulation

a) air
b) mix of air and O2

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13
Q

stepwise principles of inflation breaths in neonatal resus

A
  1. two cycles of five inflation breaths (lasting 3 secs each)
  2. if no response and HR still low, 30 seconds of ventilation breaths
  3. if STILL no response, add chest compressions
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14
Q

when are chest compressions performed in neonatal resus?

how are they performed?

A

if HR remains <60bpm despite resus and inflation breaths

performed at 3:1 ratio with vent breaths

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15
Q

delayed cord clamping in
a) uncompromised neonates
b) neonates that require resus

A

a) delay of at least 1 minute before clamping
b) cord clamped sooner - prevents delays getting to resus team

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16
Q

what is necrotising enterocolitis?

A

intestinal inflammation and death in premature babies

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17
Q

which babies are most at risk of necrotising enterocolitis?

A

premature babies

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18
Q

presentation of necrotising enterocolitis

A

neonate with:
- bilious vomiting
- reduced feeding
- abdo distension
- bloody stools

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19
Q

key investigation and results for necrotising enterocolitis

A

X-RAY (chest and abdo)
- dilated bowel loops
- portal venous gas
- intramural gas
- Rigler’s sign (air both inside and outside the bowel wall)

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20
Q

management of necrotising enterocolitis

A

STAIN:
S - surgical emergency
T - total parenteral nutrition
A - abx (vancomycin + cefotaxime)
I - IV fluids
N - nil by mouth

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21
Q

complications of necrotising enterocolitis

A

perforation, peritonitis

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22
Q

RFs for gastroschisis/exomphalos (6)

A
  1. maternal smoking
  2. alcohol
  3. illicit drug use
  4. young maternal age
  5. SES
  6. opioid prescription in pregnancy
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23
Q

when is gastrochisis/exomphalos normally diagnosed? with what? what will the result be?

A

antenatally diagnosed at 20 weeks
1. USS scan - bowel free-floating in amniotic fluid
2. maternal bloods - raised AFP

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24
Q

how does gastroschisis present in neonates?

A
  • lateral (right-side) of umbilical cord
  • abdominal contents exposed to air
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25
Q

management of gastroschisis including type of delivery (5)

A
  1. vaginal delivery can be attempted - 37/40
  2. immediate fluid resus
  3. sterile, clear covering of abdo contents
  4. surgery (if large may need staged repair)
  5. then NG tube and parenteral feeding
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26
Q

how does exomphalos present in neonates?

A
  • abdominal contents protrude through abdo wall via umbilical cord
  • covered in amniotic sac
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27
Q

conditions associated with exomphalos (3)

A
  1. Beckwith-Wiedemann syndrome
  2. DS
  3. cardiac/kidney malformations
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28
Q

management of exomphalos including type of birth

A
  1. c-section preferred (prevents sac rupture)
  2. OG tube to decompress stomach
  3. IV fluid resus
  4. staged repair surgery
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29
Q

management of exomphalos if sac ruptures

A

immediate surgical intervention

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30
Q

causes of hypoxic ischaemic encephalopathy (HIE) (6)

A
  1. maternal shock e.g. placental abruption, uterine rupture
  2. intrapartum haemorrhage
  3. prolapsed cord
  4. nuchal cord (wrapped around neck of baby)
  5. prolonged labour
  6. shoulder dystocia
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31
Q

general signs and symptoms of HIE

A
  • highly alert/v low energy
  • trouble breathing
  • not eating
  • trouble hearing
  • seizures/other neuro
  • slow HR
  • organ failure
32
Q

what system is used to stage HIE? how many stages are there?

A

Sarnat staging
3 stages - mild, moderate, severe

33
Q

mild HIE features (signs, resolves when, prognosis)

A
  1. poor feeding, generally irritable and hyper-alert
  2. resolves within 24h
  3. normal prognosis
34
Q

moderate HIE features (signs, resolves when, prognosis)

A
  1. poor feeding, lethargy, hypotonic, seizures
  2. can take weeks to resolve
  3. up to 40% develop cerebral palsy
35
Q

severe HIE features (signs, mortality)

A
  1. reduced consciousness, apnoeas, flaccid, reduced/absent reflexes
  2. up to 50% mortality
  3. up to 90% develop cerebral palsy
36
Q

what is the diagnosis of HIE often based off of?

A

child’s symptoms and problems that took place during labour/delivery

37
Q

investigations to confirm HIE diagnosis (4)

A
  1. bloods - check O2
  2. test blood in umbilical cord/examine placenta (identify cause)
  3. USS of head
  4. brain MRI (only at 4-7 days old!)
38
Q

initial management of HIE

A

therapeutic hypothermia/cooling

39
Q

therapeutic cooling for HIE
a) which babies
b) target temp
c) how long for
d) what is done after

A

a) near/at term with HIE
b) 33-34 degrees
c) continued for 72h
d) baby gradually warmed to normal temp over 6h

40
Q

supportive management for HIE

A
  • neonatal resus
  • ongoing optimal ventilation
  • circ support
  • nutrition
  • acid base balance
  • tx of seizures
41
Q

complications of HIE (3)

A
  1. permanent damage to brain - CP
  2. death
  3. delays in growth/development
42
Q

features of congenital syphilis (8)

A
  1. blunted upper incisor teeth (Hutchinson’s teeth)
  2. saddle nose
  3. saber shins (tibial malformation)
  4. rhagades (linear scars around mouth)
  5. deafness
  6. lymphadenopathy
  7. hepatosplenomegaly
  8. rash
43
Q

jaundice in the first 24 hours of life is always…

A

pathological

44
Q

causes of jaundice in first 24h (4)

A
  1. rhesus haemolytic disease
  2. ABO haemolytic disease
  3. hereditary spherocytosis
  4. glucose-6-phosphodehydrogenase deficiency (G6PD)
45
Q

causes of jaundice in days 2-14

A

normally physiological!

46
Q

causes of prolonged jaundice (>21 days in term infant, >14 in preterm infant) (5)

A
  1. biliary atresia
  2. breastmilk jaundice
  3. hypothyroidism
  4. congenital infection e.g. CMV, toxoplasmosis
  5. prematurity (immature liver function)
47
Q

investigations for prolonged jaundice

A

jaundice screen!
- conjugated and unconjugated bilirubin
- direct antiglobulin test (Coomb’s)
- TFTs
- FBC and blood film
- urine
- U&Es, LFTs

48
Q

prolonged jaundice and a raised conjugated bilirubin indicates…

A

biliary atresia

49
Q

investigations for baby presenting w jaundice in first 24h

A
  1. serum bilirubin
  2. FBC
  3. blood groups
  4. direct Coomb’s test
  5. blood film
  6. TORCH screen
  7. urine dip/microscopy
50
Q

management of prolonged jaundice

A
  • treat cause
  • phototherapy (on/above blue line)
  • exchange transfusion (on/above red line)
51
Q

what is kernicterus? what is its pathophys?

A

neurological complication of neonatal jaundice

bilirubin crosses BBB and deposits in basal ganglia

52
Q

presentation of kernicterus

A

history of jaundice then…
- floppy, drowsy baby
- poor feeding

53
Q

complications of kernicterus (3)

A
  1. CP
  2. learning disability
  3. deafness
54
Q

when is the blood spot screening test performed?

A

5-9 days of life

55
Q

innocent murmurs - 5 Ss

A

soft, systolic, short, symptomless, standing/sitting (vary w position)

56
Q

what is biliary atresia

A

congenital condition - section of the bile duct is either narrowed or absent. progressive necro inflammatory process

57
Q

pathophys of biliary atresia

A
  1. inflammation/absence of tree
  2. discontinuous/obliterated bile ducts
  3. results in cholestasis > bile cannot be transported from LIVER to bowel
  4. CONJUGATED bilirubin cannot be excreted
  5. OBSTRUCTIVE JAUNDICE
58
Q

presentation of biliary atresia

A
  • first few weeks of life
  • prolonged jaundice
  • dark urine, pale stools
  • failure to thrive
59
Q

investigations and results for biliary atresia (3)

A
  1. BLOODS
    - raised serum conjugated bilirubin
    - deranged LFTs
  2. NEWBORN SCREEN
    - rule out CF
    - usually normal
  3. ABDO USS
    - triangular cord sign
    - liver may be enlarged
60
Q

1st line tx for biliary atresia

A

Kasai procedure - portoenterostomy

(2nd line is liver transplant if end-stage)

61
Q

what is oesophageal atresia? what other conditions may it occur with?

A

congenital abnormality of the oesophagus where the upper and lower parts aren’t connected

may occur with tracheo-oesophageal fistula and polyhydramnios

62
Q

what is a tracheo-oesophageal fistula?

A

abnormal connection between oesophagus and trachea

63
Q

when is oesophageal atresia normally diagnosed?

A

antenatally

64
Q

presentation of oesophageal atresia if not diagnosed antenatally (6)

A
  1. resp distress
  2. cyanosis
  3. choking + cyanotic spells following aspiration
  4. frothy white bubbles in mouth
  5. coughing
  6. pneumonia from aspirating stomach contents
65
Q

management of oesophageal atresia

A

surgery within 12-24h

66
Q

what is duodenal atresia?

A

congenital malformation of the duodenum - doesn’t join with rest of small intestine, causing complete bowel obstruction

67
Q

what is the duodenum?

A

first part of the small intestine, connects to the stomach

68
Q

RF for duodenal atresia

A

down’s syndrome

69
Q

presentation of duodenal atresia

A

FIRST FEW DAYS OF LIFE…

  1. projectile vomiting
  2. abdo distension
  3. absent bowel movements
70
Q

main investigation and result for duodenal atresia

A

abdo x-ray - double bubble sign

71
Q

management of duodenal atresia (2)

A
  1. decompress stomach with NG
  2. surgery=
    duodenoduodenostomy
72
Q

complications of duodenal atresia (2)

A
  1. polyhydramnios > preterm labour/rupture
  2. malnutrition/weight loss
73
Q

what is transient tachypnoea of the newborn (TTN)?

A

commonest cause of resp distress in the newborn period

74
Q

what causes TNN? what is a RF?

A
  • caused by delayed resorption of fluid in the lungs
  • c-sections > lung fluid not ‘squeezed out’ during passage through birth canal
75
Q

what will be seen on CXR in TNN?

A

hyperinflation of lungs
fluid in horizontal fissure

76
Q

management of TTN

A
  • observation, supportive care
  • supplementary O2 potench

PHASE 3A (18 decks)

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