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Paeds Written - NEONATES Flashcards

1
Q

Guthrie screening conditions

A 
Congenital hypothyroidism
Sickle cell disease
Cystic fibrosis
Inherited metabolic disease
- Phenylketonuria
- Homocystinuria
- Etc.
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2
Q

Newborn method of hearing test

A

Automated/evoked otoacoustic emissions test

  • computer generated click played through earpiece
  • soft echo/emission = healthy cochlea
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3
Q

2nd line hearing test for newborns

A

Auditory brainstem response test

- performed if abnormal Otoacoustic emissions test

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4
Q

APGAR score components

A 
Appearance (colour)
Pulse
Grimace (reflex irritability)
Activity (muscle tone)
Respiratory effort
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5
Q

APGAR scores for these babies:

  1. HR 106, blue extremities, active movement, weak cry, grimace
  2. HR 98, weak cry, floppy, blue extremities, no grimace
A
  1. 2 + 1 + 2 + 1 + 1 = 7 = Good state

2. 1 + 1 + 0 + 1 + 0 = 3 = Very low

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6
Q

Rate of chest compressions in neonatal resus?

A

3: 1
compressions: breaths

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7
Q

1st step for term baby that is gasping / not breathing

A

5 inflation breaths (air)

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8
Q

Acceptable pre-ductal SpO2 for neonates

A

2 mins - 65%
5 mins - 85%
10 mins - 90%

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9
Q

Risk factors for surfactant deficiency

A 
Premature
Male
C section
diabetic mother
2nd born of premature twins
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10
Q

Diagnostic signs on imaging for Surfactant deficiency/RDS?

A

CXR –> ground glass appearance, indistinct heart border

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11
Q

Tx for surfactant deficiency?

A

Exogenous surfactant (CuroSurf) via ET tube
Assisted ventilation - CPAP
Oxygen

Preventative = maternal antenatal corticosteroids

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12
Q

Antenatal corticosteroid course?

A

24mg dexamethasone IM in 2 divided doses of 12mg 24 hours apart OR 4 divided doses of 6mg 12 hours apart

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13
Q

Evidence of Transient tachypnoea of the newborn (TTN) on imaging

A

Hyperinflation of lungs

Fluid in horizontal fissure

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14
Q

Intervention required for Transient Tachypnoea of Newborn (TTN)

A

Observation + supportive care

?Oxygen supplementation to maintain sats

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15
Q

What factors warrant a neonatal assessment (if meconium observed during delivery) ?

A 
RR >60
Grunting
HR < 100 or >160
Cap refill >3 seconds
Temp >38 (or >37.5 on 2 occasions 30 mins apart)
Sats <95%
Central cyanosis
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16
Q

Pathophysiology of Persistent Pulmonary HTN in neonate?

A

High pulmonary vascular resistance causes right to left shutting within lungs and at atrial & ductal level

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17
Q

Evidence of persistent pulmonary HTN (of neonate) on CXR?

A

Normal sized heart

Some pulmonary oligaemia (local reduction in blood perfusion)

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18
Q

Levels of treatment used for meconium aspiration?

A

Meconium fluid but no Hx GBS –> observation

Sx of infection –> IV ampicillin + IV gentamicin

Severe –> oxygen , non invasive ventilation e.g. CPAP

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19
Q

Key criteria/feature that suggests Chronic lung disease of prematurity / Bronchopulmonary dysplasia?

A

Oxygen requirement/dependence after 36 weeks corrected/adjusted age OR 28 days after birth

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20
Q

Medications that can be given in Chronic lung disease of prematurity/Bronchopulmonary dysplasia?

A

Corticosteroids - reduce lung inflammation
- BUT limit use D/T concerns about Neuro development

Diuretics - reduce excess fluid in lungs

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21
Q

Causes of perinatal asphyxia (causing HIE)

A

Failure of gas exchange across placenta - placental abruption

Interruption of umbilical blood flow - shoulder dystocia causing cord compression

Inadequate placental perfusion - maternal hypotension

Compromised foetus - IUGR

Failure to breathe at birth

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22
Q

Most important treatment for HIE

A

Therapeutic cooling / hypothermia

  • reduce to 32-36 for 24 hours
  • only Tx shown to reduce death & disability
  • only if >36 weeks gestation!
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23
Q

features of mild Hypoxic ischaemic encephalopathy

A 
Irritable
Responds excessively to stimulation
Hypertonia
Staring eyes
Hyperventilation

Complete recovery expected

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24
Q

Features of moderate Hypoxic ischaemic encephalopathy

A

Abnormal movement
Hypotonia
Cannot feed
Seizures

Good long tern prognosis if fully resolved by 2 weeks old
Otherwise bad prognosis

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25
Features of severe hypoxic ischaemic encephalopathy
NO normal movement or response to pain Fluctuating muscle tone (hypo --> hyper) Prolonged/refractory seizures +/- multi organ failure 30-40% mortality Over 80% have Neuro-disability if not cooled
26
1st line Tx for Retinopathy of prematurity
Laser photocoagulation | or cryotherapy
27
Most appropriate way of checking bilirubin: - <24 hours - 2 days - 2 weeks - >2 weeks
<24 hours = serum BR (can assume total BR = uBR) 2 days - 2 weeks = transcutaneous BR - but check with serum BR if >250 > 2 weeks = split BR (cBR and uBR)
28
Clinical features of kernicterus
``` Abnormal muscle tone - arched back Lethargy Poor feeding High pitched cry Seizures, coma Irritability ```
29
Thresholds for phototherapy in neonates
``` Term = 350 total serum BR Premature = 120 total serum BR ```
30
Thresholds for exchange transfusion in neonates
Term = 450 total serum BR Premature = 230 total serum BR
31
Management for neonate with blood glucose 0.8mmol/L
If symptomatic or <1mmol/L (very low): Admit to neonatal unit + start 10% dextrose infusion
32
Treatment for asymptomatic hypoglycaemic baby (capillary glucose 2.1)
Encourage normal feeding - breastfeeding or formula | Monitor blood glucose
33
RF for prolonged / severe hypoglycaemia as neonate:
``` Premature Maternal DM IUGR Hypothermia Neonatal sepsis Inborn errors of metabolism Others: Nesidioblastosis, Nechwith-Wiedemann syndrome ```
34
Hypoglycaemia - clinical features
Autonomic - jitteriness - tachypnoea - pallor - irritable Neuroglycopenic - poor feeding/suck - weak cry - drowsy - hypotonia - seizures Other - apnoea - hypothermia
35
Most common organisms of Early onset Neonatal sepsis
Group B strep | E coli
36
Most common organism in Late onset neonatal sepsis
staph. epidermidis Gram -ves - pseudomonas - klebsiella - enterobacter Fungi
37
Most common presentation of neonatal sepsis
Respiratory distress (85%) - grunting - nasal flaring - tachypnoea - accessory muscle use
38
Treatment levels for Neonatal sepsis
Only 1 minor RF = regular observations for 24h 2+ minor RF or 1 red flag = Abx + full septic screen
39
Red flags for possible neonatal sepsis
suspected or confirmed infection in another baby (if multiple pregnancy) parenteral abx given to mum during labour or in 24h before or after birth - for suspected invasive bacterial infection - NOT prophylaxis for GBS resp distress starting >4 hr after birth Seizures Need for mechanical ventilation AT TERM Signs of shock
40
Minor RF for neonatal sepsis
Previous baby with GBS infection Premature LBW Maternal: current GBS colonisation, current bacteriuria, inrapartum temp >38, ROM >18h, current infection incl chorioamnionitis
41
Abx treatment for suspected/confirmed neonatal sepsis
IV benzylpenicillin + gentamicin
42
Requirements for stopping Abx in suspected neonatal sepsis
CRP <10 Negative blood culture at presentation Negative blood culture again at 48h
43
Evidence of Necrotising enterocolitis (NEC) on imaging
Abdo XR Pneumatosis intestinalis (intramural gas) !!! Portal venous gas Dilated bowel loops Bowel wall oedema Rigler sign - air inside & outside bowel wall Football sign - air outlining Falciform ligament
44
Management of NEC
Barrier nursing NG tube decompression Total bowel rest + TPN Abx - cefotaxime + vancomycin Surgical R/v + If perforation --> laparotomy
45
Clinical presentation of Erb's palsy
Adduction + internal rotation of arm Pronation of forearm 'Waiter's tip'
46
Pathophysiology of Erb's palsy
Damage to brachial plexus | Usually a result of shoulder dystocia
47
Positional vs True talipes ON EXAMINATION
Positional = foot CAN be fully dorsiflexed to touch front of lower leg + normal size foot True talipes equinovarus (club foot) - cannot be fully dorsiflexed to touch front of lower leg - heel rotated inward 'varus' - heel in plantar flexion 'equinus' - entire foot inverted + supinated feet - affected foot is shorter - affected side calf muscles thinner
48
Treatment of positional talipes
Physiotherapy
49
Treatment options for True Talipes Equinovarus
Mild-moderate = Ponsetti method (plaster casting + bracing) Severe = surgery
50
Associations with Aplasia Cutis Congenita
Trisomy 13 - Patau Setleis syndrome 4p syndrome Teratogens during pregnancy e.g. carbimazole (antithyroid medication)
51
Management of aplasia cutis congenita
Conservative wound care - most lesions re-epithelialise spontaneously Surgical repair (large lesion)
52
Features of Foetal Alcohol syndrome
``` Microcephaly Smooth/absent philtrum Hypoplastic upper lip IUGR, growth retardation Low IQ, learning difficulties Cardiac malformations Epicanthic folds Short palpebral fissure ``` Withdrawal - irritable, tremors, hypotonic
53
Risk factors for cleft lip/palate
Maternal benzodiazepine use | Maternal anti epileptic use
54
Timing of definitive surgery for cleft lip/palate
3 months for lip | 6-12 months for palate
55
Complication of cleft lip/palate
Increased risk secretory otitis media | Possible airway problems - 'Pierre-Robin sequence'
56
Most common congenital diaphragmatic hernia type?
Left postero-lateral Bochdalek hernia
57
Presentation of congenital diaphragmatic hernia
Respiratory distress | Bowel sounds on auscultation of chest
58
Prognostic factors in congenital diaphragmatic hernia
Liver position - liver herniation into thorax = more severe, lower survival Lung-to-head ratio - numeric estimate of size of foetal lungs - >1 = better outcome
59
Gold standard Ix for Oesophageal atresia/Trache-oesophageal fistula
Gastrograffin swallow
60
Presentation of Oesophageal atresia/Trache-oesophageal fistula
Choking Cyanotic spells after aspiration + associated with other developmental issues
61
Definitive Tx for Biliary atresia
Kasai procedure - Dissection of abnormalities - Creation of distinct ducts - Anastomosis formation
62
Clinical features of Biliary atresia
Jaundice >14 days Dark urine, pale stools Growth + feeding issues Hepatomegaly +/- splenomegaly Cardiac murmur (if associated cardiac abnormality)
63
LFTs in Biliary atresia
High conjugated bilirubin | Raised transaminases - GGT most raised
64
Types of Biliary atresia
Type 1 = proximal ducts patent, common duct obliterated Type 2 = atresia of cystic duct, cystic structures found in porta hepatis Type 3 = atresia of left and right ducts to level of portal hepatis (>90%)
65
Management of small bowel atresia
A-E approach to stabilise neonate +/- NG decompression Surgery - primary anastomosis +/- Ladd procedure if malrotation present
66
Associations with Duodenal atresia
Down syndrome Congenital cardiac abnormalities Polyhydramnios (impaired swallow)
67
Difference between duodenal and jejuna/ileal atresia on imaging
Abdo XR ``` Duodenal = 'double bubble' sign Jejunal/ileal = air fluid levels ```
68
Low vs High anorectal anomaly
Low = anus closed over, in different position OR narrower than usual + fistula to skin High = bowel has closed end, does not connect with anus, usually associated with bladder/urethral/vaginal fistula
69
Management of anorectal malformation
Surgical correction by 9 months | - 'Anorectoplasty' + loop stoma
70
Risk factors for Sudden Infant Death Syndrome
``` Front sleeping baby Male LBW Premature Maternal smoking Microenvironment - pillows, duvet, heat ```
71
Protective factors for Sudden Infant Death Syndrome
Dummies Breast feeding Room sharing
72
Medico-legal considerations in Sudden Infant Death Sydrome
Police + Coroner always called in any case of unexpected death Police Child Protection team also involved

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