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Paeds > Perinatal and neonatal medicine > Flashcards

Perinatal and neonatal medicine Flashcards

1
Q

Rubella in pregnancy

A 
Notify health protection unit  (HPU)
HPU may want to test B19
NO effective Mx
Recommend rest, fluids and paracetamol
Stay off work, avoid contact w/other pregnant women after developing rash
Refer to obst. for risk
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2
Q

CMV in the neonate Drug Mx

A

IV ganciclovir/ PO valganciclovir

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3
Q

Toxoplasmosis in neonate Mx

A

1st line: pyrimethamine + sulfadiazine + Ca folinate

adjunct: pred

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4
Q

Newborn Hearing Screening

A

EOAR: Earphone over ear plays sound which causes echo if cochlear function is normal (if normal not achieved move onto:)
AABR: computer analyses EEG waveforms evoked by series of clicks

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5
Q

Neonatal nerve palsies

A

Most will resolve completely

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6
Q

Resp. distress syndrome

A

Oxygen and ventilation
CPAP or AV via tracheal tube possible
other: high flow hum. 02, mechanical v.,
Exogenous surfactant via ET tube

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7
Q

Neonatal pneumothorax

A

Immediate decompression + O2 + chest drain if tension

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8
Q

Neonatal PDA

A

Closed using: IV indomethacin, prostacyclin synthase inhibitor, ibuprofen
If fail: surgical ligation or percutaneous catheter device closure

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9
Q

Necrotising Enterocolitis

A

Ix: AXR, cultures
Stop oral feed
broad spec Abx (ceotaxine/vancomycin)
If perf/necrosis: surgery
Parenteral nutrition always required, often ventilatory/circulatory support
long term Cx: strictures, malabs. if resection

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10
Q

Neonatal jaundice Ix

A 
Haematocrit
Blood group of mother and baby
DAT (+did mother receive aniti-D?)
FBC and film (spherocytes)
Blood G6PD levels
Culture blood, urine, CSF if ?infection
TSH
LFTs
Bili
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11
Q

Assessment of Neonatal jaundice

A

Visually assess baby in light
Measure bilirubin:
- Serum: If jaundice within 24hrs of birth or GA <35w
- Transcutaneous: GA >35w or jaundice >24hrs of life (if >250umol check serum bili)
Check bili 6hrly until below threshold or becomes stable/falling

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12
Q

Risk of developing Kernicterus

A

increased risk if
serum bili >340umol in >37w GA
Rising >8.5umol/hr
Fx of bilirubin encephalopathy: poor feed, lethargy, hypotonia

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13
Q

Mx of neonatal jaundice

A

Threshold table:
- No Mx
- Phototherapy (+/- IVIG)
- Exchange transfusion
If baby clinically well, GA >38 and >24hrs old w/bili within 50 of phototherapy threshold:
- repeat 18hrs for any RiskFactors , 24hrs for no RF baies

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14
Q

Phototherapy in Neonatal jaundice

A

450nm (green-blue)
Photobilirubin and lumirubin
Dont need conj. -> excreted
Can stop once >50umol below Rx threshold

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15
Q

Monitoring in neonatal phototherapy

A 
Serum bili 4-6hrly
Monitor temp
protect eyes
encourage short bf breaks (<30m)
Check for rebound hyperbili at 12-18hrs
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16
Q

Indications for intensive phototherapy

A
  1. bili >8.5umol inc. /hr
  2. within 50umol of threshold for exchange trx >72hrs from birth
  3. Bili doesnt respond witihin 6hrs
    - reduce intensity once bili >50 from exchange trx threshold
17
Q

Other option for neonatal jaundice

A

IVIG - adjunct in cases of RhHDN, ABO HDN, or if serdum bili >8.5umol/hr

Exchange Trx:
Above threshold OR if Sx of bili encephalopathy
Double-volume exchange used in babies
during trx do NOT stop phototherapy
Measure serum bili within 2hrs
18
Q

PACES counselling of Neonatal jaundice

A 
Explain is common:
if: <1d, >14d will Ix cause
Physiological often
Mx: light therapy
- not harmful but eyes protected and regular bloods
- bf can continue
- need to stay in for another blood at 12-18h
Resources:
NHS choices Neonatal jaundice
Bf network
Bliss (prem/sick babies)
19
Q

Meconium Ileus

A 
gastrograffin enema (n-acetylcysteine and option too)
Sx if ineffective
20
Q

Meconium aspiration

A

Ix: CXR (?pneumomediastinum), FBC+CRP, culture
If normal term infant w/mec stained amniotic fluid but NO Hx of GBS observe
If any risk factors or lab findings suggestive of infection consider Abx: ampicillin + gent
In sev cases: O2 and CPAP

21
Q

Persistent pHTN of neonate

A 
CXR: normal heart but pulmonary oligaemia
Urgent echo to rule out CHD
Mx:
Mec. vent+circ support
Inhaled NO (vasodilator)
Sildenafil
?Oscillatory vent.
Sev. but reversible; extracorporeal membrane oxygenation
22
Q

Congenital diaphragmatic hernia

A

Once Dx large NG tube passed and suction applied to present distension of intrathoracic bowel
req. surg

23
Q

Early onset sepsis (<72hr) Ix

A 
FBC U+E CRP
Cultures
Urine dip and MSU
LP (ALL infants <1m, 1-3 appear unwell or WCC <5 or >15, (or if FNS/blood culture +ve req. examination and culture))
CXR
24
Q

Early onset sepsis Abx

A

Immediate no wait for results
IV should cover:
GBS, listeria, other G+, G-
e.g. Benzylpenicillin/amoxicillin + gentamicin
If CRP -ve and infant well Abx can be stopped after 48hrs

25
Q

Late onset sepsis >72hrs pathogens

A

Most common: coagulase -ve staph (epidermis)
others:
G+: S aureus, E faecalis
G-: klebsiella, pseudomonas

26
Q

Late onset sepsis (>72hrs) Abx

A 
Ampicillin + gent/cefotaxime
Vanc + gent
?sensitivities
Vanc for coag. -ve Staph.
if all else fails mero
NB long term broad spec ABx risks invasive fungal infection
27
Q

Neonatal meningitis

A

Uncommon but high mort and morb 1/3 maj. sequele
late Sx: bulging fontanelle, opisthotonos
Mx: ampicillin + 3rd gen ceph. (cefotaxime)
Cx: cerebral abcesss

28
Q

Paediatric sepsis 6

A
  1. O2
  2. IV access (cultures, glucose, A/C/V gases)
  3. IV broad spec Abx
  4. IV fluids
  5. Senior clinicians involved early
  6. Vasoactive intropic support considered early
    (if normal parameters not achieved after 40ml/kf resus
29
Q

GBS neontate

A

Benzylpenicillin or ampicillin
AND
Gent./cefotaxime/ceftriaxone
supportive

30
Q

Listeria monocytogenes neonate

A

amox. co-trimoxazole
NB. trimethoprim CI in preg
if systemic: IV benpen+Gent

31
Q

Conjunctivitis in the neonate

A

Clear w/water/saline in most cases
Neomycin for staph/strep Sx
Gonococcal infection: sample, stain, culture the discharge (Mx: 3rd gen ceph.)
Chlamydia: PO erythromycin 2w

Best practice:
opthalmic azithromycin/erythromycin
antihistamines/artificial tears for viral conjunctivitis

32
Q

Herpes simplex in neonate

A

If mother has primary dx or genital lesions within 6weeks of del. then c-sec
If earlier PO aciclovir from 36w
Aciclovir can be given to baby during risk period

33
Q

HBV in neonate

A

infants of HBsAg+ mothers receive vaccination after birth (birth,1m,6m) and HBV IG
Mothers: antiviral monotherapy tenofovir or lamivudine

34
Q

Neonatal hypoglycaemia

A

Prevented by early and freq feed
Glucose IV if severe
Glucagon and hydrocortisone too if you like
Aim for glucose >2mmol/L

35
Q

Cleft lip/palate

A

Specialised feeding may be req.
?airway problems (e.g. Pierre RObin)
Pre-surgical lip tapping, oral appliances, PNAM may narrow cleft
Definitive Mx: surgery

Paeds (23 decks)

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