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neonates > prematurity > Flashcards

prematurity Flashcards

1
Q

classification of prematurity based on GA

A

i. Late preterm = GA 34-37 weeks
ii. Moderate preterm = GA 32-<34 weeks
iii. Very preterm = GA 28-<32 weeks
iv. Extremely preterm = <28 weeks

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2
Q

classification of prematurity based on weight

A

i. LBW = <2500g
ii. VLBW = <1500g
iii. ELBW = <1000g

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3
Q

Rx if prem delivery is expected

A

tocolytic e.g. CCB nifedipine
Abx - benpen for GBS
MgSO4 for neuroprotection (if <30w)
steroids for respprotection (all <37w)

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4
Q

pathogenesis of ROP

A

initial insult > injury to new vessels
disruption of normal angiogenesis > retinal oedema from leaky vessels > haemorrhage

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5
Q

spastic diplegia = what basically

A

PVL

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6
Q

SGA vs FGR

A

SGA = infants with BM <10th centile for gestational age
FGR = estimated fetal weight <10th centile

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7
Q

what syndrome causes asymmetric IUGR

A

Russell-Silver = asymmetric growth impairment (head size is normal)

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8
Q

what is the barker hypothesis

A

IUGR increases risk of t2dm, insulin resistance, HTN, obesity, cvd, stroke

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9
Q

how does a foetus get vit D

A

1,25 dihydroxyvitamin D DOES NOT cross placenta
placental 24-hydroxylase, changes it to 24,25 dihydroxyvitamin D3 (a less active metabolite than its precursor)

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10
Q

which of the following causes neonatal withdrawal? which are teratogenic? which doesn’t reduce growth?
- nicotine
- alcohol
- THC
- opiates
- cocaine

A

withdrawal: alcohol, opiates (methadone > heroin), cocaine
teratogenic: alcohol, cocaine
THC only one that doesnt affect fetal growth

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11
Q

maternal smoking increases risk of

A

SIDS
T2DM
obesity
HTN
dyslipidaemia
behaviour / cognition / psychiatric issues

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12
Q

subcutaneous fat necrosis - appears like?

A

firm, indurated nodules and plaques on the back, buttocks, thighs, forearm and cheeks
Nodules and plaques may be erythematous, flesh coloured or blue

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13
Q

where are the following bleeds?
1. Caput
2. Cephalhaematoma
3. Subgaleal
4. Extradural
5. Subdural
6. Subarachnoid

A
  1. Caput – CT and aponeurosis
  2. Cephalhaematoma – periosteum and bone
  3. Subgaleal – aponeurosis and periosteum
  4. Extradural – periosteum/outer dura and bone
  5. Subdural – dura and arachnoid
  6. Subarachnoid – arachnoid and pia
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14
Q

caput succedanaeum vs cephalohaematoma

A

caput can cross midline, cephalo does not

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15
Q

cx of cephalohaematoma

A

calcification > deformity
25% underlying fracture
E.Coli infection

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16
Q

why important to differentiate a subgaleal

A

massive blood loss risk - its not bound by periosteum so can just bleed into the epidural space

17
Q

subgaleal vs caput/cephalohaematoma

A

vs cephalo: subgaleal will expand, not bound by suture lines
vs cephalo: boggy, not firm
vs caput: caput is biggest at birth

18
Q

most common fracture vs long bone fracture in delivery

A

clavicle most common
humerus most common long bone

19
Q

presentation of erb’s palsy

A
  1. Limp arm in “waiter’s tip” position – arm held in adduction, elbow extended and forearm pronated with wrist flexed
  2. Absent biceps jerk
  3. +/- phrenic nerve involvement with diaphragmatic palsy in 5%
20
Q

erb vs klumpke’s palsy

A

erb - c5-c7
klumpke - C8-T1: clawhand, wristdrop, no grasp

21
Q

MOA of phototherapy

A

converts toxic native Z bilirubin to lumirubin (E bilirubin), a isomer that the kidneys can excrete

22
Q

what kind of CP does kernicterus cause

A

choreoathetoid CP

23
Q

NAS normally onset on what day

A

day 3***

24
Q

naloxone in NAS - comment

A

NOOO can induce rapid withdrawal&raquo_space; seizures

25
Q

symptoms of NAS

A

CNS: high pitched cry, hypertonia, tremors, seizures
ANS: excoriation, diaphoresis, temp instability
GIT: poor feed, uncoordinated suck, vomits, excoriation

26
Q

umbilical granuloma - what? presents as? NTBM

A

low-grade infection of umbilical stump
Presents soon after cord separation as red, friable granulation tissue in region of umbilicus.
Discharge of urine or faeces from umbilicus suggests Urachal or Vitello-intestinal duct anomalies

27
Q

congenital clouding of cornea
- most common cause
- infectious cause
- stupid exam cause

A

most common = congenital glaucoma
infectious = herpes / rubella
all MPS

28
Q

duodenal atresia, think what syndrome

A

T21

29
Q

indomethacin and NEC - comment

A

• Indomethacin increases risk of spontaneous perforation but NOT NEC

30
Q

nitric oxide and B12- comment

A

prolonged NO suppresses liver enzymes&raquo_space; inactivates B12&raquo_space; B12 neuropathy/myelopathy/encephalopathy

31
Q

at what gestation does nutritive sucking occur

A

Between 32 weeks gestation and term, infants learn to coordinate sucking and swallowing with breathing, and develop adaptive aerodigestive protective mechanisms

32
Q

some ddx for neonatal hypertension

A

renal
- congenital: pckd, obstructive
- acquired: AKI, nephrocalcinosis
vascular
- thrombi, RAS
resp = BPD
endocrine = CAH, hyperthyroid

33
Q

define hydrops fetalis

A

2 or more abnormal fetal fluid collections
i. Ascites
ii. Pleural effusion
iii. Pericardial effusion
iv. Skin oedema = late sign of fetal hydrops

34
Q

etiology of hydrops fetalis

A

immune (20%)
non-immune (80%)
- cardiovascular 40%
- anaemia 30%
- metabolic
- other: lymphatic obstructive issues, hypoproteinaemia

35
Q

causes of raised antenatal AFP

A

Abdominal wall defects,
renal disease,
materno-fetal bleed,
annular pancreas,
duodenal atresia,
epidermolysis bullosa

36
Q

clinical tetrad of chronic kernicterus

A
  1. Sensory neural hearing loss.
  2. Dental enamel hypoplasia.
  3. Choreoathetoid cerebral palsy.
  4. Oculomotor paresis of upward gaze.
37
Q

explain paradoxical cyanosis in choanal atresia

A

when the infant begins crying, they unconsciously begin mouth breathing, usually leading to the signs of respiratory distress and cyanosis to disappear.

neonates (4 decks)

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