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Paeds > Premature / LBW / NICU > Flashcards

Premature / LBW / NICU Flashcards

1
Q

What type of small babies can you get [3]

A

SGA
LBW
IUGR

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2
Q

What causes LBW [5]

A 
Idiopathic
Placental insufficiency
Chromosomal, Malformation
Infection - TORCH / CMV / syphillis
Monochorionic monoamniotic  twins
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3
Q

What causes placental insufficiency [5]

A 
Maternal factors: 
IHD, DM
High BP, PET 
Placental Abruption 
Sickle cell  
Smoking / alcohol
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4
Q

What are common problems in LBW [8]

A
  1. Perinatal hypoxia - increased haematocrit, bilirubin and plasma viscosity
    = Polycytheaemia as hypoxia = produce more
  2. Hypoglycaemia
  3. Hypothermia
  4. Thrombocytopenia - BM concentrating on making RBC
  5. NEC
  6. Meconium aspiration syndrome as stressed
  7. IRDS as less surfactant
  8. Infection
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5
Q

What are long term problems of LBW [5]

A 
DM, Obesity
Hypertension, IHD, Stroke
Reduced Growth 
Renal failure
Lung - asthma
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6
Q

What is mild LBW and what is considered extreme

A

LBW <2.5kg

Extreme <1kg

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7
Q

What is symmetric LBW [2]

A

OFC and weight in the same percentile

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8
Q

Pathogenesis of symmetric IUGR

What causes symmetric [4]

A

1st trimester insult
Affects all DNA

Chromosomal
Infection / TORCH
Teratogens
Severe smoke / alcohol

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9
Q

Will symmetric LBW improve

A

Unlikely as will never have enough cells

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10
Q

What is asymmetric [2]

A

OFC spared

Weight <10 centile

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11
Q

What causes asymmetric LBW [3]

A

3rd trimester insult
Placental insufficiency
PET
Small amount of smoking/drug use

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12
Q

Why is LBW associated with hypothermia

A

Lack of fat stores

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13
Q

Why is LBW associated with hypoglycaemia

A

No glycogen reserve as IUGR throughout pregnancy so constantly used up

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14
Q

Hematological sequelae of hypoxic state in utero of LBW babies cause [5]

A
  • Increased haematocrit 20-22 (normal 18-20)
  • Increased bilirubin as have to break down
  • Increased plasma viscosity (VTE / slow circulation)
  • Polycythaemic to increase RBC as hypoxic
  • Thrombocytopenia as BM making RBC
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15
Q

How do you treat the hypoxic state of LBW babies

A

Partial exchange transfusion

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16
Q

Why does premature make you more prone to infection [3]

A

IgG transfer in 3rd trimester
Immune system is underdeveloped
Interventions in premature
Chorioamnionitis

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17
Q

Do you worry more about pre-term but appropriate for gestational age or the pre-term SGA?

A

Pre-term appropriate gestational age higher risk of complications
SGA baby will have been under stress in the womb so produce natural steroids to mature lungs

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18
Q

What is most important in LBW babies

A

Nutrition

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19
Q

What causes pre-term babies [4]

A

Idiopathic
External: Smoking, Malnutrition
Maternal infection (chorioamnionitis), PET, DM
Factors that stretch womb: Polyhydramnios, Twins
APH, PPROM

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20
Q

What is term

A

37-42

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21
Q

Mild prematurity

A

32-37

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22
Q

Moderate

A

28-32

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23
Q

Extreme

A

<28 weeks

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24
Q

What is important if premature [5]

A 
Fluid - dextrose
TPN if long term, Syringe feed, NG
Vitamins Abidec
Iron at 28 days 
Establish feet
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25
Q

Complications of respiratory distress syndrome if untreated? [3]

A

Respiratory distress
Exhaustion
Respiratory failure - hypoxia/. hypercapnia

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26
Q

What are RF for IRDS [3]

A

Pre-term
DM
C-section

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27
Q

How do you Dx [2]

A

Blood gas

CXR - indistinct heart border

28
Q

How do you prevent [2]

A

Antenatal steroid, 12 hours apart

Delay birth with tocolytics

29
Q

How do you Rx [2]

A

O2 - nasal or mask or just flow to maintain pressure

CPAP - open and inflate alveoli after intubation

30
Q

Complications [4]

A

Retinopathy
Renal failure due to hypoxia
PTX
Bronchopulmonary dysplasia

31
Q

When do you use CPAP

A

If only problem is keeping airway open

32
Q

What is Ddx of IRDS [5]

A 
Sepsis
TTN
Meconium aspiration
Congenital lung
Cardiac anomaly
33
Q

What causes bronchopulmonary dysplasia [4]

Pathophysiology [2]

A
  • volume barotrauma
  • atelectasis
  • oxygen toxicity
  • infection via ETT

inflammation and scarring of lungs (necrotising bronchiolitis with alveolar fibrosis)

34
Q

What does bronchopulmonary dysplasia cause [4]

A

Persistent hypoxia
Difficulty weaning off ventilation
Severe bronchiolitis
Poor feeding

35
Q

How do you treat bronchopulmonary dysplasia [4]

A

Steroids
Surfactant
High calories feeding
diuretics (SPIRNOLACTONE and FUROSEMIDE)

36
Q

What are complications of bronchopulmonary dysplasia [5]

A 
GORD
Feeding issue 
Decreased IQ
Cerebral palsy 
Asthma
37
Q

What minor issues is there in terms of respiration [3]

A

Apnoea >15s
Desaturation
Irregular breathing

38
Q

How do you treat minor respiratory problems in premature infants [2]

A

Caffeine - neuroprotective and stimulates resp

NCPAP

39
Q

When does IVH occur
Ax
Px [2]

A

First 72 hours
Ax: rupture of germinal matrix blood vessels
Px:
- blood vessels in germinal matrix, lateral to ventricles lack structural support and rupture
- particularly with abnormal cerebral autoregulation

40
Q

Signs of IVH [8]

A 
Seizure
Bulging fontanelle
Cerebral irritability, drowsiness
Diminished or absent moro reflex
Poor muscle tone
Apnoea 
Pallor, cyanosis
Failure to suck, shrill cry
41
Q

How do you Dx [3]

A

Cranial USS as fontanelle hasn’t closed
MRI
Bloods

42
Q

How do you Rx [3]

A

Fluid replacement
Anticonvulsants
Acetazolamide to prevent post-hemorrhagic hydrocephalus

43
Q

What do you do if hydrocephalus / raised ICP [2]

A

Drainage

Shunt

44
Q

What are complications of IVH [3]

A

Post haemorrhagic hydrocephalus if clot occlude
Decreased IQ
Cerebral palsy

45
Q

What types of intracranial haemorrhage are there

A

IVH = most common in pre-term
SAH
Subdural after forceps

46
Q

What causes hypoxic ischaemic encephalopathy? [7]

What is HIE?

A 
IVH
Placental insufficiency, abruption
Cord prolapse
Long delivery
Maternal hypoxia
Infection
Anaemia

HIE is brain injury secondary to hypoxic ischemic insult and reperfusion injury

47
Q

What does mild HIE present with [2]

A

Hyperalert

Hypertonia

48
Q

HIE associated symptoms [3]

Ix [2]

A

Resp depression
Coma
Encephalopathy within first 24h ie seizures

Ix: capillary gas (at birth pH <7 and base excess -12), flat line in EEG

49
Q

Describe EEG in HIE

A

EEG

Flat single line

50
Q

How do you Mx HIE[4]

A

Support seizure
Avoid hyperthermia
Therapeutic hypothermia
Cranial USS, MRI and neurodevelopmental f/u

51
Q

What are the complications HIE [5]

A 
Cerebral palsy
Epilepsy 
Blind
Deaf
Learning difficulty
52
Q

Describe general resuscitative management in HIE [4]

Describe therapeutic hypothermia [2]

A

General principles:

  • Intermittent positive pressure ventilation (IPPV)
  • Avoid hyperthermia
  • Cerebral function analysis monitoring
  • Phenobarbital

Therapeutic hypothermia:
- baby cooled to 33o for 72h and then rewarmed slowly over 12h with sedation

53
Q

Ax of neonatal sepsis. Differentiate between early and late onset by the typical causative organisms [3]

Risk factors of early onset sepsis [5]
Risk factors of late onset sepsis [5]

A

Early onset: transplacental or ascending infection by GBS, E.coli, listeria
Late onset: environmental infection by coagulase negative staphylococci, staph aureus, GBS, candida

Risk factors:

  • Early onset: prolonged rupture of membranes, maternal infection, preterm labour, fetal distress, mucosal/skin breaks in neonate
  • Late onset: central lines and catheters, congenital malformations e.g. spina bifida, severe illness, malnutrition, immunodeficiency
54
Q

How does sepsis present? [7]

A 
Fever/hypothermia
Resp distress
Poor feeding, lethargy
Jaundice 
Hypoglycaemia, Seizure
Shock, Collapse 
DIC
55
Q

What are the complications of group B strep [5]

A 
Meningitis
DIC
Pneumonia, Respiratory failure
Hypotension
Shock
56
Q

How long does GBS last

A

Early = 1 week

Can recur up to 3 months

57
Q

How do you investigate sepsis? [7]

A 
Admit NICU 
SEPSIS 6 protocol
FBC, CRP (repeat as could be delayed)
Blood cultures
VBG, Glucose
CXR
LP
58
Q

What do you do if 1 RF

A

Observe

59
Q

What do you do if 2RF or red flag

A

Full sepsis screen
IV Ax to baby
Even if no signs

60
Q

What antibiotics to give EMPIRICALLY:
Early onset [2]
Late onset [2]

A

Early onset:

  • IV pencilling or vancomycin
    • gentamicin

Late onset:

  • IV flucloxicillin
  • +gentamicin
61
Q

When can you stop gent

A

2x CRP <4

62
Q

What do you do when cultures back? [4]

A

Vanc if MRSA
Metronidazole If surgical or abdominal concerns
Cefotaxime for meningitis
Amoxicillin for listeria

63
Q

Etiology of neonatal hypoglycemia - describe 3 mechanisms

A
  • Limited glucose supply: prematurity, perinatal stress
  • Hyperinsulinism: diabetic mothers, labetalol use in pregnancy
  • Increased glucose utilisation: SGA, LGA, hypothermia, sepsis
64
Q

What should all irritable babies get [3]

A

U+E
BG
Sepsis screen

65
Q

How do you treat [3]

A

IV 10% glucose
Regular electrolyte if on fluid
Hydrocrotisone

66
Q

What causes haemorrhage disease of newborn

A

Vit K defiicency

67
Q

How does HDON present [3]

A

Bruising
Jaundice
IVH / kidney

Paeds (33 decks)

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